FORM NO. 3: TECHNICAL DESIGN AND IMPROVEMENT CHECKLIST

The following item(s) (does, does not) conform with or does not apply (NA) to the requirements of §§ 155.035 through 155.092. Those items not conforming are explained on the final page.

   Does      Does Not   NA                  Item

                     General

1.                                                  Conformance with major street plan

2.                                                  Conformance with zoning regulations, or if no zoning 154.048(C)

3.                                                  No flood hazards

4.                                                  Acceptable natural drainage and erosion control

5.                                                  Steep slopes not limiting factor

6.                                                  Large trees and other significant natural features

7.                                                  Areas of historical or cultural significance

                     Streets

8.                                                  Right-of-way widths

9.                                                  Pavement widths

10.                                                  Radius of curvature

11.                                                  Horizontal visibility

12.                                                  Vertical alignment and visibility

13.                                                  Grades

14.                                                  Cul-de-sacs

15.                                                  Turn around radius - ROW - and pavement

16.                                                  Dead-end streets

17.                                                  Dedication and addition of half streets

18.                                                  Marginal access streets, points of access and planting strips

19.                                                  Parks and open spaces

20.                                                  Type of water supply

21.                                                  Test walls

22.                                                  Types of sewage treatment

23.                                                  Percolation test results

24.                                                  Storm drainage system type

25.                                                  Manholes

26.                                                  Catch basins

27.                                                  Headwalls

28.                                                  Sufficient easements for utilities or open drainage

29.                                                  Other utilities

30.                                                  Underground utilities

Date ________________                  _____________________________

                              Title of Position

                           _____________________________

                                 Signature