Name(s) of Subdivider(s) ____________________ _____________________
Address(es) _____________________ _____________________
Phone(s) _____________________ _____________________
Subdivider's Representative (if any) and Registered Land Surveyor (if any):
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Name(s)
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_____________________ |
_____________________ |
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Address(es)
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_____________________ |
_____________________ |
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Phone(s) |
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_____________________ |
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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 ____________