Date ________________ Application Number ________________
Subdivision ________________________________________________________________
The following item(s) (does, does not) conform with the requirements of the City of Washington Subdivision Regulations.
Those items not conforming are explained on the final page:
Does Does Not Item
1. Name of subdivision (no duplication permitted)
2. Locational description
3. Name and address of owner, subdivider, surveyor and engineer
4. Sheet size not larger than 24" x 36" (index sheet, if more than one sheet)
5. Proper scale
6. Date and north point
7. Vicinity map
8. Names of adjacent subdivisions and owners
9. Zoning classification of all major parcels and proposed changes
10. Topography at 2 intervals
11. Location, width, and names of existing streets, rights-of-way, easements
12. Location and dimensions of existing building and parks
13. Corporation, township, range, section lines
14. Location of existing utilities including sewers, water lines, and communication lines or poles
15. Layout, names and widths of proposed streets or easements and proper dedications
16. Layout and approximate dimensions of all lots
17. Building setback lines
18. Survey monuments of adjacent properties
19. Parks and open spaces and proper dedications
20. Proposed use of lots
21. Copies of proposed deed restrictions, if any
22. Sewage treatment and percolation test results
23. Adequate preliminary improvement plans
24. Construction estimates
25. Required certifications
Date ________________ _____________________________
Title of Position
_____________________________
Signature