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 Phone Country Phone Number FaxEmail 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 Phone Country Phone Number FaxEmail 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 Phone Country Phone Number FaxEmail LocationSubdivision NameProperty Location/Street Address Street Address Tax Parcel ID NumberTotal AcreageNumber of Acres to be DevelopedProposed Use Single-Family Two-Family Townhouses Multi-Family Commercial Industrial Other SpecifyZoning DistrictWater Supply Public Other Specify (Water Supply)Sewage Disposal Public Other Specify (Sewage Disposal)Phasing Check Here if Not Applicable Total number of phasesPhase number this applicationTotal AcresAcres this phaseTotal LotsLots in this phaseExisting/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 informationApplicant, 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 ApplicantName of Partnership ApplicantSignature PartnerName of Corporate ApplicantSignatureTitle
