12-14-6: FINAL PLAT APPROVAL FORM:

Date    

1.   Name of subdivision

2.   Location:       1/4 Section       Township       Range      

For Amended Plats:       Lot(s)       Block(s)

    Subdivision

3.   Name, address and telephone number of subdivider:

4.   Name, address and telephone number of persons of firms providing services and information (e.g., surveyor, engineer, designer, planning consultant, attorney):

5.   Descriptive Data:

   a.   Gross area in acres:    

b.   Number of lots or rental spaces:    

c.   Existing zoning or other regulations   

6.   Date preliminary plat approved:    

7.   Any conditions?          (If yes, attach list of conditions.)

8.   Any deed restrictions or covenants?          (If yes, attach a copy.)

9.   All improvements installed?          (If no, attach a subdivision improvements agreement or guarantees.)

10.   List of materials submitted with this application:

a.      

b.      

c.      

d.      

e.      

f.      

I do hereby certify that all the statements and information and the statements and information contained in all exhibits transmitted herewith are true. I hereby apply to the governing body for approval of the final plat of    

(Name of Subdivision)

Subdivider

FOR OFFICIAL USE ONLY

1.   Application number    

2.   Date application submitted    

3.   Date by which final plat must be approved or rejected    

(Ord. 784, 8-6-2007)