APPLICATION FOR SUMMARY REVIEW PLAT APPROVAL

INSTRUCTIONS

Print or type clearly. Use additional sheets if necessary. All required attachments shall be submitted with this application form. Incomplete or inaccurate applications may delay decision dates. The completed application package must be submitted to the County [appropriate county staff member] by the subdivider or a designated agent and shall be in compliance with the requirements of the County Subdivision Regulations. Each application must be accompanied by the required administrative fee.

APPLICANT INFORMATION

1. Subdivider Name____________________________________________________________________
    Address_________________________________________________________________
    Phone Number ________________________________
    Signature ______________________________________ Date _________________________

2. Engineer/Surveyor Name_______________________________________________________________
  Address__________________________________________________________________
  Phone Number _________________________________
  Signature ____________________________________________ Date _______________________

SUBDIVISION INFORMATION

3. Location of Subdivision (attach map if necessary) _____________________________________________
_____________________________________________________________________________________

4. This is a Type Three ______ Five_____ Subdivision (check one)

5. Number of lots:  ______ Total acreage:  ______ Acres ______ Size of smallest lot: ______ Acres

6. Municipal planning and platting jurisdiction (if applicable):  _______________________________________

SUPPLEMENTAL INFORMATION

7. If it is determined by the County to be necessary, attach an improvement agreement to ensure completion of required improvements.

8. All affidavits, certificates, permits, and statements required for summary review plats as defined by the County Subdivision Regulations shall be attached to this application.

9. The original drawing and required number of copies of the summary review plat map shall be attached to this application.

10. The final disclosure statement shall be attached to this application.

11. Date of pre-application conference_____________________ Signed _______________________________

12. Date application received by County ______________________ Signed___________________________

13. Date summary review plat deemed complete______________ Signed _______________________________

14. Date summary review plat approved by County __________________________

15. Date summary review plat filed with County Clerk _____________________