APP. NO. S
DATE RECEIVED
APPLICATION FOR SKETCH PLAN REVIEW
NAME(S) OF SUBDIVIDER(S) _________________________________________________________
ADDRESS _________________________________________________________
PHONE(S) _________________________________________________________
Subdivider's Registered Land Surveyor ________________________ Phone: ______________________
I (we) hereby request sketch plan review and certificate of approval of the following described subdivision in accordance with the provision of the County of Miami Subdivision Ordinance. I (we) am (are) the owner of the real estate included in the subdivision.
Name of Subdivision
Section Township Range in Township
County Road N S E W
(Legal description attached hereto)
Area in Acres __________ Number of Lots Zoned
Electrical Sewage: Private Public Sidewalk: Yes No
Water: Public Well
Major Subdivision Minor Subdivision
The undersigned, having been duly sworn on oath states the above information is true and correct as he is informed and believes.
Signature(s) of Subdivder(s)
State of Indiana)
County of Miami) SS
Subscribed and sworn to before me this day of , 20
Notary Public
Residing in County My Commission Expires
(Ord. 6-2002, passed 3-4-02)