Date Application No.
1. Name of Applicant
Address
Phone(s)
2. Name of Surveyor or Engineer
Address
Phone
3. Proposed Name of Subdivision
4. Location
(In addition, please attach a copy of legal description)
5. Proposed Use
6. Present Zoning District
7. Proposed Zoning Changes, if any
8. Area Number of Lots
9. Do you propose deed restrictions? Yes No (If yes, attach a copy)
10. List all proposed improvements and utilities and state your intention to post a performance guarantee prior to actual installation
Improvement | Guarantee |
a. | |
b. | |
c. | |
d. | |
e. | |
f. |
11. List other materials submitted with this application
Item |
a. |
b. |
c. |
d. |
Signature of Applicant
Signature of Surveyor/Engineer
(For Commission Use)
Date Received
Date of Commission Meeting
Action by Commission: APPROVED DISAPPROVED
If plat disapproved, reason(s) for disapproval
Signature of Chairperson
Signature of Secretary
(Ord. O-28-2021, passed 11-16-2021)