Subdivision Of Land Application ApplicantName First Last Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneFax Email Property OwnerProperty Owner Check Here if Same as Applicant Name First Last Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneFax Email Engineer/Architect/Surveyor:Name First Last Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneFax Email LocationSubdivision Name Property Location/Street Address Street Address Tax Parcel ID Number Total Acreage Number of Acres to be Developed Proposed Use Single-Family Two-Family Townhouses Multi-Family Commercial Industrial Other Specify Zoning District Water Supply Public Other Specify (Water Supply) Sewage Disposal Public Other Specify (Sewage Disposal) Phasing Check Here if Not Applicable Total number of phases Phase number this application Total Acres Acres this phase Total Lots Lots in this phase Existing/proposed agreements with adjacent properties (Right-of-way)? Yes No Describe (Right-of-way) Existing/proposed agreements with adjacent properties (Easements)? No Yes Describe (Easements) Comments/other information Applicant, being duly sworn, says he/she is: (Please mark the appropriate response) The owner of the property in questions The authorized agent for the owner of record of the property for which the application is made. The owner’s signed and notarized authorization to his/her agent to act on owner’s behalf is required to be submitted. Has an equitable interest in the property as submitted and documentation is attached to this application. All information provided is true and correct to the best of my knowledge: Signature of Individual Applicant Name of Partnership Applicant Signature Partner Name of Corporate Applicant Signature Title
