REQUEST FOR SECONDARY APPROVAL OF SUBDIVISION PLAT
File No. S-
Date Received
FOR STAFF USE:
Plat required:
______ Determination of conformance S-___ Date approved: ___________
______ Additional approval Prelim. S-___ Date approved: ___________
______ Restrictive Covenants received Date
NAME(S) OF SUBDIVIDER(S) _________________________________________________________
ADDRESS _________________________________________________________
PHONE(S) _________________________________________________________
I (we) do hereby request determination of conformance with the preliminary plat for the following described subdivision in accordance with the provisions of the Comprehensive Plan. I (we) am (are) the owner (s) 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):
__________________________________________________________________________________________
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 Subdivider(s) ______________________________ ________________________________
(Ord. 6-2002, passed 3-4-02)