APPENDIX A: PRELIMINARY STEPS CERTIFICATION

Applicant Name:                                                    

Address:                                                               

Phone #:                                                               

FAX #:                                                                 

Email Address:                                                      

Name of Subdivision:                                             

Utility Service Provider Information:                                                      

Utility Type	Company/Agency Name	Contact Name	Address	Phone Number
Sanitary Sewer
Storm Sewer
Water
Electric
Gas
Telephone
Cable/ Communications
Other

 

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)