Name(s) of Subdivider(s)       ____________________          _____________________

 

Address(es)                            _____________________         _____________________

 

Phone(s)                                 _____________________         _____________________

 

Subdivider's Representative (if any) and Registered Land Surveyor (if any):

 

Name(s)

 

 

 

_____________________

_____________________

Address(es)

 

 

 

_____________________

_____________________

Phone(s)

 

 

_____________________

_____________________

 

I (we) do hereby request primary approval of the following described subdivision in accordance with the provisions of the Lapel Subdivision Ordinance.  I (we) am (are) the owner (owners) of the real estate included in the subdivision.

 

Name of the Subdivision ______________________________generally described as  follows:

 

Civil Township _____Section_____Quarter Section_____Township_____Range______

 

Area in acres___________________________________; Number of lots____________

 

Miles of new streets to be dedicated to the public (in hundredths):

 

Full width__________________________

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The undersigned, having been duly sworn on oath states the above information is true and correct as he is informed and believes.

 

Signature(s) of Subdivider(s) ________________________      ____________________ Subscribed and sworn to before me this day of _______________________, 19___.

________________________

Notary Public

Residing in _________________County

My Commission Expires: _________

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Staff Use: Date of  Public Hearing before Commission  ___________________________

Fee For Additional Lots of  $_______received from subdivider.  Date ____________