APPLICATION FOR A WATERSHED SUBDIVISION APPROVAL
Date of Application Application Number
On a separate sheet of paper, list the Deed Book and Page Number, the parcel size and the Tax Map and Lot Number for each parcel of land (if one parcel, list here.)
Watershed name:
Critical area: Yes, No.
Name of owner/applicant:
Corporation name/state:
Mailing address:
Street address:
City, state and zip:
Telephone number: Alternate:
General description of work under this application:
Name of proposed subdivision:
Type of subdivision: Residential Commercial Industrial Other
Number of parcels/lots: (Smallest Lot: acres Largest Lot: acres)
I certify that the information shown above is true and accurate, and is in compliance with the conditions for a subdivision of land as defined in the Watershed Protection Ordinance.
SEAL
Owner/Attorney in Fact
Owner/Attorney in Fact
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OFFICIAL USE
Date Received: Date referred to Board:
Notes:
SUBDIVISION PLAT CHECKLIST
The plat shall be clearly and legibly drawn at a scale of not less than one inch to one hundred feet (1" = 100') (1" = 200' in extreme cases). The plat shall be prepared by a Registered Surveyor and shall include the following information prior to consideration by the Watershed Review Board:
Name of Subdivision:
Date Submitted:
Location:
Owner:
Address:
Telephone No:
Surveyor:
Address:
Telephone No:
Engineer:
Address: Telephone No.
Checklist:
(a) Title Block:
Approved Disapproved
Subdivision name, subdivider’s name, north arrow, scale (denoted graphically and numerically), date of plat preparation, location of subdivision (township, county and state), name and seal of registered surveyor preparing plat, deed book reference.
(b) Vicinity Map:
Approved Disapproved
A sketch vicinity map showing the location of the subdivision in relation to the surrounding area. If the subdivision is a portion of a larger tract, the map is to show the relation of the subdivision to the larger tract.
(c) Tract Boundaries:
Approved Disapproved
The boundaries of the tract or portion thereof to be subdivided, with all bearings and distances shown.
(d) Property Lines:
Approved Disapproved
Property lines and owner’s names of abutting properties and/or abutting subdivisions of record.
(e) Natural Features:
Approved Disapproved
Significant natural features including marshes, lakes or streams, or other natural features affecting the site.
(f) Existing Features:
Approved Disapproved
Existing features including structures and built-upon area and the Roxboro City Limit lines both on or adjacent to the land to be subdivided.
(g) Topographic Lines:
Approved Disapproved
Topographic contour lines not to exceed ten foot intervals when the area to be subdivided exceeds four acres. (If required by the Watershed Administrator or the Watershed Review Board.)
(h) Lots and Street Lines:
Approved Disapproved
All proposed lot and street right-of-way lines with approximate area and dimensions, lot numbers and proposed use of land.
(i) Drainage System:
Approved Disapproved
Proposed drainage facilities, including approximate location and dimensions of open drainage ways, storm sewers, culverts, retaining ponds or areas where water is to be diverted through grading.
(j) Site Data:
Approved Disapproved
Total acreage in tract to be subdivided, smallest lot size (square feet) and total number of lots.
(k) The following documentation is to accompany the application:
Written evidence acknowledging the submission and approval of the required Soil Erosion and Sedimentation Control Plan.
WATERSHED PROTECTION PERMIT
APPLICATION FOR A WATERSHED PROTECTION PERMIT
Date of Application Application Number
On a separate sheet of paper, list the Deed Book and Page Number, the parcel size and the Tax Map and Lot Number for each parcel of land (if one parcel, list here).
Watershed Name:
Name of Owner/Applicant:
Corporation Name & State:
Mailing Address:
Street Address:
City, State, Zip:
Telephone Number:
General Description of Work
I certify that the information shown above is true and accurate, and is in compliance with the conditions for a subdivision of land as defined in the Watershed Protection Ordinance.
SEAL
Owner/Attorney in Fact
Owner/Attorney in Fact
******************************************************************************************
OFFICIAL USE
Date Received: Date Referred to Board:
Notes:
(Ord. passed 6-18-10)