FORM 1. APPLICATION FOR PRELIMINARY PLAT APPROVAL
(To be Filed in Duplicate)
DATE
1. Name of Subdivision
2. Name of Applicant Phone
Address
3. Name of Local Agent
Address
4. Owner of Record Phone
Address
5. Engineer
Address
6. Land Surveyor Phone
Address
7. Attorney Phone
Address
8. Subdivision Location: One the side of .
(Street)
feet of .
(Street)
9. Zoning District
10. Total Acreage Number of Lots
Fee required at $ per lot
11. Tax Map Designation: Section Lot(s)
The applicant hereby consents to the provisions of the subdivision regulations providing that the decision of the Planning Commission shall be made within thirty (30) days after the close of the public hearing on final plat approval.
Attached hereto is an affidavit of ownership indicating the dates the respective holdings of land were acquired, together with the book and page of each conveyance into the present owner as recorded in the County Recorder of Deed’s (County Clerk’s) Office. This affidavit shall indicate the legal ownership of the property, the contact owner of the property, and the date the contract of sale was executed.
STATE OF
COUNTY OF ss:
I, hereby depose and say that all of the above statements and the statements contained in the papers submitted herewith are true.
Mailing Address
(Street)
(City) (State) (Zip)
Subscribed and sworn to before me this day of 20 .
Notary Public
MY COMMISSION EXPIRES:
12. Has the Zoning Board of Appeals (Zoning Board of Adjustment) granted a variance, exception, or special permit concerning this property?
13. Is any open space being offered as part of this subdivision application?
If so, what amount?
14. Is any variance from the Subdivision Regulations requested?
If so, describe
15. List all and proposed to be subdivided:
16. Owners of land 100 feet adjacent or opposite:
17. Attach seventeen (17) copies of proposed preliminary plat.
18. Attach three (3) copies of construction plans.
19. List all contiguous holdings in the same ownership: