SUBMITTAL APPLICATION

ENGINEERING  DEPARTMENT 
                                                                                               
                                                                                                  Project No.__________________________

PARCEL NUMBER(S):

EXISTING ZONING:

GROSS AREA (ACRE/SQ. FT.):

TOWNSHIP-RANGE-SECTION:

DEVELOPMENT/PROJECT NAME:

ADDRESS/LOCATION:


PROPERTY OWNER:

ADDRESS:

CITY:

STATE:

ZIP CODE:

PHONE NUMBER:

FAX NUMBER:

CONTACT PERSON:                                                              E-MAIL:   


APPLICANT:

ADDRESS:

CITY:

STATE:

ZIP CODE:

PHONE NUMBER:

FAX NUMBER:

CONTACT PERSON:                                                              E-MAIL:


ARCHITECT/ENGINEER:

ADDRESS:

CITY:

STATE:

ZIP CODE:

PHONE NUMBER:

FAX NUMBER:

CONTACT PERSON:                                                              E-MAIL:

	SUBDIVISION ONLY

NUMBER OF LOTS:

NUMBER OF TRACTS:

LINEAR FEET OF STREETS:

MINIMUM LOT AREA:

AVERAGE LOT AREA:

MINIMUM LOT WIDTH:


OWNER'S SIGNATURE:
DATE:


APPLICATION CONTACT


I hereby request that all verbal and written communication regarding the attached application be provided to:

            ________________________________________________

            ________________________________________________

            ________________________________________________

            TELEPHONE:	_________________________________

            FAX NUMBER:	_________________________________
            
            E-MAIL:  	_________________________________



Additionally, I understand that it is the above listed person's responsibility to communicate any verbal or written communications on said application to other members of the development team, including, but not limited to application comments, staff reports, action letters, meeting times, etc.




________________________________________________		_____________________
Applicant's Signature							Date




















OWNERSHIP VERIFICATION


It is requested that a 					 application be accepted by the Development Engineering Department for property generally located: 

______________________________________________________________________________________


Said property is owned by:
                                            AND
____________________________________________	_____________________________________________

____________________________________________	_____________________________________________

____________________________________________	_____________________________________________

Telephone Number: __________________________	Telephone Number: ____________________________


The subject property is legally described as:________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

____________________________________________________________________________(or see attached).

The subject property contains __________ gross acres (includes right-of-way to the centerline of adjacent street or alley) 

                  AND
                          __________ net acres (excludes adjacent perimeter right-of-way).

Tax Parcel Number: ___________________

Attached is a map/survey which accurately portrays the parcel configuration and property dimensions, as reflected in the legal description.

I hereby certify that the above information and information submitted as part of the requested application is correct, and that I am authorized to file an application on said property, being either the owner of record or authorized to file on behalf of the owner.  (If not owner of record, attach written authorization from owner.)


______________________________________________________	________________________
Applicant's Signature			 					Date	

Submittal_Application.doc			Page 1 of 3				 Udated 10/18/06