REQUEST FOR PRIMARY APPROVAL OF SUBDIVISION PLAT
File No. S-
Date Received
NAME(S) OF SUBDIVIDER(S) _________________________________________________________
ADDRESS _________________________________________________________
PHONE(S) _________________________________________________________
I (we) do hereby request primary approval of the following described subdivision in accordance with the provisions of the Comprehensive Plan. I (we) am (are) the owners of the real estate included in said subdivision.
Name of Subdivision generally described as follows:
Section __________ Township __________ Range __________ in ________________Township
Containing acres Number of Lots
Miles of new street to be dedicated to the public (in hundredths): Full Width Half Width
Name of Registered Land Surveyor Phone ___________
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
FOR STAFF USE: Date of public hearing before Commission
Fee for additional lots of $ from Subdivider Date
(Ord. 6-2002, passed 3-4-02)