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Name of Subdivision:
Utility Service Provider Information:
I certify that to the best of my knowledge, the information provided above pertaining to utility service providers for the proposed subdivision is accurate and that a copy of the proposed subdivision has been provided to said utility providers for planning purposes.
Applicant Signature: Date:
The applicant shall submit this completed form to the Wadsworth City Planning Commission at the time of preliminary plat application.
(‘65 Code, Part Thirteen, Appendix A) (Am. Ord. 08-026, passed 6-3-08)