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Date Application Received: Date Application Certified as Complete: Applicant Name (Printed): Applicant email (Printed): Applicant Phone Number: Subdivision Name Applicant requests that the preliminary plat and final plat are acted upon in one application? Yes (See City Code section 6-3-3-2 to verify request is valid) No, the preliminary plat and final plat will be applied for separately Application shall contain the following: Six copies of the preliminary plat of the proposed subdivision drawn in accordance with the requirements hereinafter stated; each copy of the preliminary plat shall be on good quality paper, shall have dimensions of not less than twenty four inches by thirty six inches (24" x 36"), shall be drawn to a scale of not less than one inch to one hundred feet (1"=100'), shall show the drafting date, and shall indicate thereon, by arrow, the general northerly direction. Or PDF Copy Subdivision Application Form - Preliminary Plat Application Submit completed application to the Planning and Zoning Administrator Preliminary Plat Fees Preliminary Plat Review Base Fee $500.00 Advertisement for Public Hearing Fee $500.00 Preliminary Plat Review per Lot Fee $10.00 per lot Water Modeling Assessment Fee $300.00 **Office Use Only** Preliminary Plat Application April 2024 Page 1 of 5 ---PAGE BREAK--- The following shall be shown on the preliminary plat or shall be submitted separately: The names, addresses and telephone numbers of the subdivider or subdividers and the engineer or surveyor who prepared the plat. The name and address of all adjoining owners of property within a radius of three hundred feet (300') of the boundaries of the proposed subdivision, whether or not bisected by a public right of way as shown on record in the County Assessor's office. A statement of the intended use of the proposed subdivision, such as: residential single-family; two-family and multiple housing; commercial; industrial; recreational or agricultural and a showing of any sites proposed for parks, playgrounds, schools, churches or other public uses. The legal description of the subdivision (One paper or electronic PDF copy and one electronic copy in Microsoft Word format) Six sets of preliminary engineering plans (not meant to be cross-sections or detailed designs) for streets, water, sewers, sidewalks and other required public improvements; however, such engineering plans shall contain sufficient information and detail to enable the Engineer to make a determination as to conformance of the proposed improvements to applicable regulations, ordinances and standards. Or PDF Copy Written application requesting approval of the preliminary plat (this document) Appropriate information that sufficiently details the proposed development within any special development area, such as hillside, planned unit development, flood plain, cemetery, mobile home, large scale development, hazardous and unique areas of development. (Ord. 901, 10-18-1976) The name of the proposed subdivision Applicant shall provide evidence that the applicant can sign this application on behalf of the property owner or developer or be said property owner or developer per section 6-2-1 (Subdivider) Preliminary Plat Application April 2024 Page 2 of 5 ---PAGE BREAK--- Yes, a copy is included No, there are none proposed at this time Yes, a copy is included No, there is no variance requested A vicinity map showing the relationship of the proposed plat to the surrounding area (1/2 mile minimum radius, scale optional). A statement as to whether or not a variance, as specified in chapter 7 of this title, will be requested with respect to any provision of this title describing the particular provision, the variance requested, and the reasons therefor. (Ord. 901, 10- 18-1976) Information required for chapter 5 of this title shall be furnished on all subdivisions. Any dedications to the public and/or easements, together with a statement of location, dimensions and purposes of such. A copy of any proposed restrictive covenants and/or deed restrictions. Any proposed or existing utilities, including, but not limited to, storm and sanitary sewers, irrigation laterals, ditches, drainages, bridges, culverts, water mains, fire hydrants, electric lines, gas lines, telephone lines and other similar utilities. A site report showing proposed water supply and sewage disposal systems. Contour lines, shown at five foot intervals where land slope is greater than ten percent (10%) and at two foot intervals where land slope is ten percent (10%) or less, referenced to an established bench mark, including location and elevation. Lot lines and blocks showing the dimensions and numbers of each. Streets, street names, rights of way and roadway widths, including adjoining streets or roadways. The land use and existing zoning of the proposed subdivision and the adjacent land. A map of the entire area scheduled for development if the proposed subdivision is a portion of a larger holding intended for subsequent Preliminary Plat Application April 2024 Page 3 of 5 ---PAGE BREAK--- Additional information provided by the applicant (if any): Preliminary Plat Application April 2024 Page 4 of 5 ---PAGE BREAK--- Applicant Signature: Date: By signing, you are confirming you have provided all required items listed on this application This application shall not be considered complete (nor will a Public Hearing be scheduled) until Staff has received all required information. Once the application is deemed complete, Staff will notify the Applicant of the scheduled hearing date, fees due, and/or any additional items. Preliminary Plat Application April 2024 Page 5 of 5