§ 2. FORMS.
PRELIMINARY DEVELOPMENT PLAN CHECKLIST
A PRE-FILING MEETING is required prior to submittal of documentation. Contact the Department of Planning and Development, 14701 Cumberland Road, Suite 300, Noblesville, IN 46060, 317-776-6325.
Complete the list below and submit it along with the application, filing fee and other required documentation by the deadline.
FAILURE TO SUBMIT ALL THE ITEMS LISTED BELOW ON OR BEFORE THE FILING DEADLINE WILL RESULT IN THE APPLICATION NOT BEING DOCKETED ON THE PLAN COMMISSION AGENDA. STAFF WILL REVIEW THE TOTAL SUBMISSION WITHIN FIVE (5) DAYS AFTER SUBMITTAL AND NOTIFY THE APPLICANT OF THE NOTICE TO PROCEED WITH THE APPLICATION'S HEARING DATE.
Two (2) complete copies of proposed plans must be submitted with application.
APPLICANT      STAFF
_____      _____   1.   Completed application including notarized signatures of owner(s) and applicant(s)
_____      _____   2.   A check in the amount of $700 plus $25 per acre (MAXIMUM FEE: $5,000)
_____      _____   3.   A separate check in the amount of $50 as surety for sign placement on property
_____      _____   4.   Attach legal description of the property involved in the planned development
_____      _____   5.   Sketch plan showing the location of planned development, ownership, use, and zoning of adjacent properties
_____      _____   6.   Site plans indicating proposed streets, all buildings with their yards and use, common open space, recreational facilities, parking areas, buffer areas, service areas and other facilities that indicate the CHARACTER of the planned development (Minimum size: 24" by 36")
_____      _____   7.   Preliminary development plans and feasibility statements for (1) roads including the classification, right of way widths, pavement widths, (2) sidewalks or pathways (3) sanitary sewers; (4) storm drainage; (5) water supply system; (6) street lighting; (7) any proposed signage; and (8) other public utilities (Minimum size: 24" by 36")
_____      _____   8.   Landscape Concept Plan showing the landscape intent, types of plant materials to be provided, intensity and scale of landscape with site details to fully explain the concept
_____      _____   9.   General Information on all service facilities, driveways, private streets, paths and ofd street parking facilities
_____      _____   10.   Statement listing the exceptions from the requirements of the base zone and reasons for the zoning change explaining why the existing zoning would not accommodate the proposed development
_____      _____   11.   Explanation of the proposed Planned Development including how the proposed Planned Development meets the objectives of all adopted land use policies
_____      _____   12.   Statement of present and proposed ownership of all land within the project
_____      _____   13.   Development schedule Indicating the stages in which the project will be constructed. Emphasizing the area, density, use and public facilities to be developed with each stage and approximate time line
_____      _____   14.   Proposed ordinance and covenants of the Planned Development District
ADDITIONAL DOCUMENTATION MAY BE REQUIRED PRIOR TO THE PLAN COMMISSION MEETING
ADDITIONAL REQUIREMENTS
_____      _____   14 SETS OF PLANS MUST BE SUBMITTED FOR REVIEW BY THE TECHNICAL ADVISORY COMMITTEE
RESIDENTIAL PLANNED DEVELOPMENTS
_____      _____   ARCHITECTURAL PLANS FOR ALL PROPOSED DWELLINGS AND OTHER BUILDINGS INDICATING 360-DEGREE BUILDING ELEVATIONS WITH SUFFICIENT DETAIL TO UNDERSTAND THE STYLE AND DESIGN OF ALL BUILDINGS INDCLUDING BUT NOT LIMITED TO THE NUMBER, SIZE, AND TYPE OF DWELLING UNITS. A NARRATIVE MAY BE ATTACHED TO DESCRIBE ANY COMMITMENTS FOR THE ARCHITECTURAL DESIGN. EIGHT (8) SETS ARE TO BE SUBMITTED ON PAPER NO LARGER THAN 11" BY 17"
NON-RESIDENTIAL PLANNED DEVELOPMENTS
_____      _____   A COMPLETE SET OF 360-DEGREE COLOR BUILDING ELEVATIONS FOR EACH PROPOSED STRUCTURE IN SUFFICIENT DETAIL TO DETERMINE THE MATERIALS USED, COLORS, AND OTHER BUILDING ELEMENTS ARE PROPOSED. LEGEND DETAILING MATERIALS/COLORS. TWO (2) SETS ON 11" BY 17" PAPER
PRELIMINARY PLANNED DEVELOPMENT
DISTRICT APPLICATION
APPLICATION # _______________________   FILING DATE ___________
THIS APPLICATION MUST BE COMPLETED AND ACCOMPANIED BY THE REQUIRED INFORMATION (SEE ATTACHED LIST). IT MUST BE FILED AT LEAST 42 DAYS PRIOR TO THE PLAN COMMISSION PUBLIC HEARING DATE BY THE LEGAL OWNERS OF FIFTY PERCENT (50%) OR MORE OF THE REAL ESTATE INVOLVED IN THIS PETITION. THE UNDERSIGNED OWNER(S) OF THE PROPERTY HEREBY REQUESTS THE CONSIDERATION OF A CHANGE OF ZONING TO A PRELIMINARY PLANNED DEVELOPMENT DISTRICT.
APPLICANT'S NAME _______________   TELEPHONE # ____________________
APPLICANTS ADDRESS ________________________________________________
PROPERTY OWNER'S NAME ____________________   TELEPHONE # __________
PROPERTY OWNER'S MAILING ADDRESS __________________________________
ATTORNEY'S NAME _____________________   TELEPHONE #________________
ARCHITECT'S NAME ____________________   TELEPHONE # _______________
ENGINEER'S NAME _____________________   TELEPHONE # _______________
SURVEYOR'S NAME _____________________   TELEPHONE # _______________
EXISTING      PRESENT ZONE      PROPOSED ZONE
USE __________   DISTRICT __________   DISTRICT ______________
16-DIGIT PARCEL ID #(s) ___________________________________________
PROPOSED NAME OF PLANNED DEVELOPMENT ______________________________
The undersigned, having been duly sworn, upon oath says that above information is true and correct as he/she is informed and believes.
______________________________      ___________________________
Signature of Applicant            Signature of Owner***
______________________________      ___________________________
Printed or Typewritten Name         Printed or Typewritten Name
Subscribed and sworn to before me,      Subscribed and sworn to before
this ____ day of _______, 200__      me, this ____ day of _______, 200__
______________________________      ___________________________
Notary Public                  Notary Public
______________________________      ___________________________
Printed/Typewritten Name            Printed/typewritten Name
My Commission expires ______         My Commission expires _____
***If the owner is not available to sign the application, a notarized statement acknowledging that the owner is aware of the Planned Development proceedings is required.
DETAILED DEVELOPMENT PLAN CHECKLIST
Department of Planning and Development, 14701 Cumberland Road, Suite 300, Noblesville, IN 46060 317-776-6325
Complete the list below and submit it along with the application, filing fee and other required documentation by the deadline.
FAILURE TO SUBMIT ALL THE ITEMS LISTED BELOW ON OR BEFORE THE FILING DEADLINE WILL RESULT IN THE APPLICATION NOT BEING DOCKETED ON THE PLAN COMMISSION AGENDA. STAFF WILL REVIEW THE TOTAL SUBMISSION.
APPLICANT      STAFF
_____      _____   1.   Completed application including notarized signatures of owner(s) and applicant(s)
_____      _____   2.   A check in the amount of $250 plus $20 per acre (MAXIMUM FEE: $5,000)
_____      _____   3.   A survey of the entire area with accurate legal descriptions for both all subdivided lands and un-subdivided lands
_____      _____   4.   A Secondary Plat for (name of subdivision) then followed by the words "A detailed development plan"
_____      _____   5.   Final Detailed Site Plan designating the following:
               a.   the land divided into conventional lots, open space areas, and building areas
               b.   infrastructure improvements Including construction details
               c.   detailed landscaping plan induding common and botanical names, sizes at the time of installation as well as at maturity, quantities of plants
               d.   permanent signage, lighting, and street fixtures
               e.   any additional information as may have been required by the Plan Commission or Common Council
_____      _____   6.   Certifications, seals, and signatures requirement for the dedication of land and the recording of the document as required by the Unified Development Ordinance
_____      _____   7.   Tabulations on each separate subdivided use area, including land area, number of buildings and number of dwelling units per acre
_____      _____   8.   Common Open Space Documents
               a.   conveyed to a municipal or public corporation
               b.   conveyed to a not-for-profit corporation or entity established for the purposes of benefiting the owners and tenants of the Planned Development or adjoining property owners
               c.   guarantee by restrictive covenants describing the open space and its maintenance and improvements
_____      _____   9.   IMPROVEMENTS - A guarantee of performance. The owner or developer shall guarantee the completion of all required improvements and facilities by either completing the improvements and having them accepted by the City Engineer in advance of the Detailed Plan Approval or submitted an -irrevocable letter of credit or other surety deemed sufficient by the City Engineer in an amount equal to a minimum of 125% of the construction cost estimate
_____      _____   10.   Construction schedule
_____      _____   11.   Proposed deed restrictions and or covenants of the subdivision
_____      _____   12.   Fourteen (14) sets of plans must be submitted for review by the Technical Advisory Committee (TAC)
ADDITIONAL DOCUMENTATION MAY BE REQUIRED
DETAILED DEVELOPMENT PLAN APPLICATION
Department of Planning and Development
APPLICATION # _______________________   FILING DATE ___________
THIS APPLICATION MUST BE COMPLETED AND ACCOMPANIED BY THE REQUIRED INFORMATION (SEE ATTACHED LIST). IT MUST BE FILED ON THE PLAN COMMISSION FILING DEADLINES. THE UNDERSIGNED OWNER(S) OF THE PROPERTY HEREBY REQUEST THE CONSIDERATION OF A DETAILED DEVELOPMENT PLAN.
APPLICANT'S NAME _______________   TELEPHONE # ____________________
APPLICANT'S ADDRESS ________________________________________________
PROPERTY OWNER'S NAME ____________________   TELEPHONE # __________
PROPERTY OWNER'S MAILING ADDRESS __________________________________
ATTORNEY'S NAME _____________________   TELEPHONE #________________
ARCHITECT'S NAME ____________________   TELEPHONE # _______________
ADDRESS ___________________________________________________________
ENGINEER'S NAME _____________________   TELEPHONE # _______________
ADDRESS ___________________________________________________________
EXISTING ZONING DISTRICT ____________   TOTAL ACREAGE _____________
16-DIGIT PARCEL ID #(s) ___________________________________________
NAME OF PLANNED DEVELOPMENT AND SECTION ___________________________
MILES OF NEW STREETS DEDICATED FOR PUBLIC USE _____________________
ACREAGE FOR OPEN SPACE ______________   DENSITY PER ACRE __________
The undersigned, having been duly sworn, upon oath says that above information is true and correct as he/she is informed and believes.
______________________________      ___________________________
Signature of Applicant            Signature of Owner***
______________________________      ___________________________
Printed or Typewritten Name         Printed or Typewritten Name
Subscribed and sworn to before me,      Subscribed and sworn to before
this ____ day of _______, 200__      me, this ____ day of _______, 200__
______________________________      ___________________________
Notary Public                  Notary Public
______________________________      ___________________________
Printed/Typewritten Name            Printed/typewritten Name
My Commission expires ______         My Commission expires _____
***If the owner is not available to sign the application, a notarized statement acknowledging that the owner is aware of the Planned Development proceedings is required.
A CHANGE OF ZONING CHECKLIST
A PRE-FILING MEETING is required prior to submittal of documentation. Contact the Department of Planning and Development, 14701 Cumberland Road, Suite 300, Noblesville, IN 46060, 317-776-6325.
Complete the list below and submit it along with the application, filing fee and other required documentation by the deadline.
FAILURE TO SUBMIT ALL THE ITEMS LISTED BELOW ON OR BEFORE THE FILING DEADLINE WILL RESULT IN THE APPLICATION NOT BEING DOCKETED ON THE PLAN COMMISSION AGENDA. STAFF WILL REVIEW THE TOTAL SUBMISSION AND NOTIFY THE APPLICANT OF THE NOTICE TO PROCEED WITH THE APPLICATION'S HEARING DATE.
APPLICANT      STAFF
_____      _____   1.   Completed application including notarized signatures of owner(s) and applicant(s)
_____      _____   2.   A check in the amount of $550 plus $20 per acre (MAXIMUM FEE: $5,000)
_____      _____   3.   A separate check in the amount of $50 as surety for the sign placement
_____      _____   4.   The proposed change of zoning amendment submitted in ordinance form (three originals unbound)
_____      _____   5.   A statement of how the proposed change of zoning relates to the adopted Comprehensive Master Plan for the City of Noblesville's zoning jurisdiction
_____      _____   6.   A vicinity map showing the location of the property including parcel lines, all existing improvements, proposed improvements, and existing zoning districts within one-quarter mile of the area for the zone map change
ADDITIONAL DOCUMENTATION MAY BE REQUIRED
A CHANGE OF ZONING APPLICATION
(ZONE MAP AMENDMENT)
Department of Planning and Development
 
APPLICATION # _______________________   FILING DATE ___________
THIS APPLICATION MUST BE COMPLETED AND ACCOMPANIED BY THE REQUIRED INFORMATION (SEE ATTACHED LIST). IT MUST BE FILED AT LEAST 42 DAYS PRIOR TO THE PLAN COMMISSION PUBLIC HEARING DATE BY THE LEGAL OWNERS OF FIFTY PERCENT (50%) OR MORE OF THE REAL ESTATE INVOLVED IN THIS PETITION. THE UNDERSIGNED OWNER(S) OF THE PROPERTY HEREBY REQUEST THE CONSIDERATION OF A CHANGE OF ZONING.
APPLICANT'S NAME _______________   TELEPHONE # ____________________
APPLICANT'S ADDRESS ________________________________________________
PROPERTY OWNER'S NAME ____________________   TELEPHONE # __________
PROPERTY OWNER'S MAILING ADDRESS __________________________________
ATTORNEY'S NAME _____________________   TELEPHONE #________________
ADDRESS ___________________________________________________________
TOWNSHIP NAME _______________   SECTION ____   TWP _____ RANGE ____
16-DIGIT PARCEL ID #(s) ___________________________________________
EXISTING      PRESENT ZONE      PROPOSED ZONE
USE __________   DISTRICT __________   DISTRICT ______________
ATTACHED LEGAL DESCRIPTION OF THE PROPERTY FOR THE CHANGE OF ZONING.
The undersigned, having been duly sworn, upon oath says that above information is true and correct as he/she is informed and believes.
______________________________      ___________________________
Signature of Applicant            Signature of Owner***
______________________________      ___________________________
Printed or Typewritten Name         Printed or Typewritten Name
Subscribed and sworn to before me,      Subscribed and sworn to before
this ____ day of _______, 200__      me, this ____ day of _______, 200__

______________________________      ___________________________
Notary Public                  Notary Public
______________________________      ___________________________
Printed/Typewritten Name            Printed/typewritten Name
My Commission expires ______         My Commission expires _____

***If the owner is not available to sign the application, a notarized statement acknowledging that the owner is aware of the change of zoning (zone map amendment) proceedings is required.
PRIMARY PLAT CHECKLIST
A PRE-FILING MEETING is required prior to submittal of documentation. Contact the Department of Planning and Development, 14701 Cumberland Road, Suite 300, Noblesville, IN 46060, 317-776-6325.
Complete the list below and submit it along with the application, filing fee and other required documentation by the deadline.
FAILURE TO SUBMIT ALL THE ITEMS LISTED BELOW ON OR BEFORE THE FILING DEADLINE WILL RESULT IN THE APPLICATION NOT BEING DOCKETED ON THE PLAN COMMISSION AGENDA. STAFF WILL REVIEW THE TOTAL SUBMISSION WITHIN FIVE (5) DAYS AFTER SUBMITTAL AND NOTIFY THE APPLICANT OF THE NOTICE TO PROCEED WITH THE APPLICATION'S HEARING DATE.
Two (2) complete copies of proposed plans must be submitted with application.
APPLICANT      STAFF
_____      _____   1.   Completed application including notarized signatures of owner(s) and applicant(s)
_____      _____   2.   A check in the amount of $500 plus $10 per lot (MAXIMUM FEE: $5,000)
_____      _____   3.   A separate check in the amount of $50 as surety for sign placement on property
_____      _____   4.   Attach legal description of the property
_____      _____   5.   Sheet size not to exceed 24" by 36"; scale 1"= 50'; north arrow and date
_____      _____   6.   Sketch plan showing the location, ownership, use, zoning of adjacent properties and property to be subdivided
_____      _____   7.   Vicinity Map indicating the location of property in relation to highways, county roads, legal drains, flood hazard areas, and other physical features in the area
_____      _____   8.   Location, width, names, dimensions of existing and proposed streets; including rights-of-way and dedications; and easements, drainage ways, etc.
_____      _____   9.   Landscape Concept Plan showing the landscape intent, types of plant materials to be provided, intensity and scale of landscape with site details to fully explain the concept
_____      _____   10.   Location and dimensions of existing parts, buildings, and open spaces
_____      _____   11.   Location of existing utilities including sewers, water lines, communication lines and poles
_____      _____   12.   Contours at vertical intervals of two (2) feet or less, if the general slope of the site is less than 10%. At vertical intervals of five (5) feet or less, if the general slope of the land is 10% or greater
_____      _____   13.   Tract boundary lines showing dimensions, bearings, angles, and references to corporation, section, township, and range lines
_____      _____   14.   The layout of lots showing dimensions, square footage of each lot, yard setbacks of building setback lines, distances, radii and chords
_____      _____   15.   Preliminary plans and feasibility statements for (1) roads including the classification, right of way widths, pavement widths; (2) sidewalks or pathways; (3) sanitary sewers; (4) storm drainage; (5) water supply system; (6) street lighting; (7) any proposed signage for identification of subdivision; (8) flood hazard areas; and (9) other public utilities
_____      _____   16.   Provide drawing indicating the proposed sanitary sewers with connections to main sewer system, lift stations, and other appurtenances, if any. If private sewage system provide a drawing locating the system in relation to a well, residential structure and adjacent lot systems. Private sewage systems shall be installed according to the Hamilton County Health Department standards
_____      _____   17.   A statement of the proposed use of the lots, stating the type of housing (single-family, two-family, multi-family) with number of proposed units. If it is a commercial or industrial plat, identify type of use so as to reveal the affect of the development on traffic, fire hazards, or congestion of population
_____      _____   18.   Proposed covenants and restrictions of subdivision
_____      _____   19.   Fourteen (14) sets of plans must be submitted for review by the Technical Advisory Committee (TAC)
ADDITIONAL DOCUMENTATION MAY BE REQUIRED PRIOR TO THE PLAN COMMISSION MEETING
PRIMARY PLAT APPLICATION
Department of Planning and Development
APPLICATION # _______________________   FILING DATE ___________
THIS APPLICATION MUST BE COMPLETED AND ACCOMPANIED BY THE REQUIRED INFORMATION (SEE ATTACHED LIST). IT MUST BE FILED AT LEAST 42 DAYS PRIOR TO THE PLAN COMMISSION PUBLIC HEARING DATE BY THE LEGAL OWNERS OF FIFTY PERCENT (50%) OR MORE OF THE REAL ESTATE INVOLVED IN THIS PETITION. THE UNDERSIGNED OWNER(S) OF THE PROPERTY HEREBY REQUEST THE CONSIDERATION OF A PRIMARY PLAT.
APPLICANT'S NAME _______________   TELEPHONE # ____________________
APPLICANT'S ADDRESS ________________________________________________
PROPERTY OWNER'S NAME ____________________   TELEPHONE # __________
PROPERTY OWNER'S MAILING ADDRESS __________________________________
ATTORNEY'S NAME _____________________   TELEPHONE # _______________
ENGINEER'S NAME _____________________   TELEPHONE # _______________
SURVEYOR'S NAME _____________________   TELEPHONE # _______________
TOWNSHIP NAME _______________   SECTION ____   TWP _____ RANGE ______
DIMENSIONS OF SUBDIVISION ________________   TOTAL ACREAGE ________
16-DIGIT PARCEL ID #(s) ___________________________________________
PROPOSED NAME FOR PRIMARY PLAT ____________________________________
The undersigned, having been duly sworn, upon oath says that above information is true and correct as he/she is informed and believes.
______________________________      ___________________________
Signature of Applicant            Signature of Owner***
______________________________      ___________________________
Printed or Typewritten Name         Printed or Typewritten Name

Subscribed and sworn to before me,      Subscribed and sworn to before
this ____ day of _______, 200__      me, this ____ day of _______,                         200__
______________________________      ___________________________
Notary Public                  Notary Public
______________________________      ___________________________
Printed/Typewritten Name            Printed/typewritten Name
My Commission expires ______         My Commission expires _____

***If the owner is not available to sign the application, a notarized statement acknowledging that the owner is aware of the Primary Plat proceedings is required.
SECONDARY PLAT CHECKLIST
Department of Planning and Development, 14701 Cumberland Road, Suite 300, Noblesville, IN 46060, 317-776-6325
Complete the list below and submit it along with the application, filing fee and other required documentation by the deadline.
FAILURE TO SUBMIT ALL THE ITEMS LISTED BELOW ON OR BEFORE THE FILING DEADLINE WILL RESULT IN THE APPLICATION NOT BEING DOCKETED ON THE PLAN COMMISSION AGENDA.
APPLICANT      STAFF
_____      _____   1.   Completed application including notarized signatures of owner(s) and applicant(s)
_____      _____   2.   A check In the amount of $250 plus $10 per lot (MAXIMUM FEE: $5,000)
_____      _____   3.   Name of subdivision followed by the words "Secondary Plat"
_____      _____   4.   Scale 1"= 50'; north arrow and date
_____      _____   5.   The secondary plat should have incorporated all modifications required by the Plan Commission or members of the Technical Advisory Committee; otherwise it shall conform to the primary plat and may constitute only that portion of the overall approved primary plat which the sub-divider proposes to record and develop at this time, provided that such portion conforms to the Unified Development Ordinance and meets the approval of the Plan Commission
_____      _____   6.   Accurate boundary lines with dimensions and angles, which provide a survey of the tract of land and closing with an error of not more than one foot in five thousand feet
_____      _____   7.   Accurate dimensions of easements for utilities and any limitations on such easements
_____      _____   8.   Accurate dimensions of any property to be dedicated or reserved for public, semi-public or community use
_____      _____   9.   Lot numbers and dimensions
_____      _____   10.   Building setback lines and dimensions
_____      _____   11.   Location of, type, material of monuments shall meet the Noblesville Standards or those of the County depending on jurisdiction
_____      _____   12.   Plans and specifications for all public improvements required in the Unified Development Ordinance as well as any other applicable standards
_____      _____   13.   Restrictions of all types which will run with the land and become covenants in the deeds to the lots
_____      _____   14.   Profiles, typical cross-sections, locations, specifications and other explanatory data for the installation of sanitary and storm sewers or private well and septic systems, roads, and water distribution
_____      _____   15.   Certification seals and signatures as required for the dedication of land and recording of the plat as set forth in the Unified Development Ordinance, Noblesville Standards or as required by the County as per jurisdiction
_____      _____   16.   A certified statement by a registered professional engineer or as required by the City Engineer as to the estimated cost for all public improvements
_____      _____   17.   Three (3) copies on reproducible mylar or KC5 no larger than 15.5" by 17" for recording purposes
_____      _____   18.   Fourteen (14) sets of construction plans must be submitted for review by the Technical Advisory Committee (TAC)
ADDITIONAL DOCUMENTATION MAY BE REQUIRED
SECONDARY PLAT APPLICATION
Department of Planning and Development
APPLICATION # _______________________   FILING DATE ___________
THIS APPLICATION MUST BE COMPLETED AND ACCOMPANIED BY THE REQUIRED INFORMATION (SEE ATTACHED LIST). IT MUST BE FILED AT LEAST 42 DAYS PRIOR TO THE PLAN COMMISSION PUBLIC HEARING DATE BY THE LEGAL OWNERS OF FIFTY PERCENT (50%) OR MORE OF THE REAL ESTATE INVOLVED IN THIS PETITION. THE UNDERSIGNED OWNER(S) OF THE PROPERTY HEREBY REQUEST THE CONSIDERATION OF A SECONDARY PLAT.
APPLICANT'S NAME _______________   TELEPHONE # ____________________
APPLICANT'S ADDRESS ________________________________________________
PROPERTY OWNER'S NAME ____________________   TELEPHONE # __________
PROPERTY OWNER'S MAILING ADDRESS __________________________________
ENGINEER'S NAME _____________________   TELEPHONE # _______________
ENGINEER'S ADDRESS ________________________________________________
SURVEYOR'S NAME _____________________   TELEPHONE # _______________
SURVEYOR'S ADDRESS ________________________________________________
TOWNSHIP NAME _______________   SECTION ____   TWP _____ RANGE ______
DIMENSIONS OF SUBDIVISION ________________   TOTAL ACREAGE ________
16-DIGIT PARCEL ID #(s) ___________________________________________
SECONDARY PLAT NAME AND SECTION ___________________________________
MILES OF NEW STREETS TO BE DEDICATED FOR PUBLIC USE _______________
The undersigned, having been duly sworn, upon oath says that above information is true and correct as he/she is informed and believes.
______________________________      ___________________________
Signature of Applicant            Signature of Owner***
______________________________      ___________________________
Printed or Typewritten Name         Printed or Typewritten Name
Subscribed and sworn to before me,      Subscribed and sworn to before
this ____ day of _______, 200__      me, this ____ day of _______, 200__
______________________________      ___________________________
Notary Public                  Notary Public
______________________________      ___________________________
Printed/Typewritten Name            Printed/typewritten Name
My Commission expires ______         My Commission expires _____
***If the owner is not available to sign the application, a notarized statement acknowledging that the owner is aware of the Secondary Plat proceedings is required.
(Ord. 04-01-03, passed 2-11-03; Am. Ord. 12-04-17, passed 4-25-17)