FORM 4. CHECKLIST FOR FILING OF FINAL SUBDIVISION PLAT
Plat Name                                                                                                                        
Location                                                                                                                           
Owner                                                                                                                              
1.   Date of Final Approval                                                                                            
   Date(s) of Reapproval                                                                                              
2.   Bonds or Escrow Deposits:
   Public Improvement                                                                                                
   Sewer                                                                                                                    
   Other                                                                                                                     
   Other                                                                                                                     
   (Bond Resolution Provided on                                                                                 )
3.   Fees: (To Planning Commission)
   A.   Money in lieu of land                                                                                   
   B.   Two percent (2%) Inspection Fee or actual cost, whichever is the least.
   C.   Money in lieu of public improvement                                                             
   D.   Street signs                                                                                                  
   E.   Other                                                                                                          
   F.   Other                                                                                                          
4.   Map:
   Received                                                                                                                
   Checked:
                                    a.   Signature block
                                    b.   Owner’s signature
                                    c.   Seal(s)
                                    d.                                            
                                    e.                                            
                                    f.                                            
                                    g.                                            
5.   Instruments Necessary for Public Improvements (Checked by (City Engineer and City Attorney))
   (a)   Off-Site (Easements, Servitudes, Arrangements, Deeds)
      1.                                                                                                               
      2.                                                                                                               
      3.                                                                                                               
      4.                                                                                                               
   (b)   Streets
      1.                                                                                                               
      2.                                                                                                               
      3.                                                                                                               
      4.                                                                                                               
      5.                                                                                                               
FORM 4. CHECKLIST FOR FILING OF FINAL SUBDIVISION PLAT (Cont.)
   (c)   Road Widening (City, Town, State, Village)
      1.                                                                                                               
      2.                                                                                                               
      3.                                                                                                               
      4.                                                                                                               
   (d)   On-Site Drainage (Easements)
      1.                                                                                                               
      2.                                                                              
      3.                                                                                                               
   (e)   Sewer Line (Easements)
      1.                                                                                                               
      2.                                                                                                               
         (Purpose)
   (f)   Reserved Lands
      1.                                                                                                               
      2.                                                                                                               
   (g)   Other Right-of-Way
      1.                                                                                                               
      2.                                                                           
   (h)   Conformity to Engineering Report
                                                                                                                        
(Instruments checked above to be recorded immediately)
            APPROVED FOR FILING:                                                      
                         City Engineer
                                                                                                        City Attorney
6.   To Planning Commission
   1.   List of Stockholders                                                                       
   2.   Performance Bonds                                                                       
   3.   (a)   Off-Site Instruments                                                                    
      (b)   Title Report*                                                                       
      (c)   Releases of Any Existing
         Mortgages                                                                       
   4.   (a)   On-Site Instruments                                                                    
      (b)   Agreement of Dedication                                                                 
      (c)   Title Report*                                                                       
      (d)   Releases of Any Existing
         Mortgages                                                                       
      *Can be included in one title report.
   5.   Water Supply Distribution
      Formation (Special District)                                                                    
   6.   Sanitary Sewer Formation
      (Special District)                                                                       
      Instruments Received                                                                    
      Instrument Approved                                                                       
Filed                                                                          
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