COUNTY SUBDIVISION REGULATIONS

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 Subdivision Review Officer 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, and Phone Number:

2. Engineer/Surveyor Name, Address, and Phone Number:

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:

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.

PROCEDURAL INFORMATION (To be completed by County Staff)

11. Date of pre-application conference:

Initial:

12. Date application received by County:

Initial:

13. Date summary review plat deemed complete:

Initial:

14. Date summary review plat approved by County:

15. Date summary review plat filed with County Clerk:

___ The foregoing Application for Summary Review is approved.

___ The foregoing Application for Summary Review is incomplete. Please provide the following information and/or documents so that your request for summary plat approval can be processed: ________________________________________________.

___ The foregoing Application for Summary Review is hereby denied for the following reasons:

_____________________________________________________________________________

______________________________________________________________________________

Date: ____________________ ___________________________________

Subdivision Review Officer