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APPLICATION for REVIEW of MINOR SUBDIVISION for the TOWN of IRA PLANNING BOARD 2487 West Main Street, Cato, NY 13033 Phone: [PHONE REDACTED], Ext. 5 1. Subdivider (if owner, so state, if agent or other type of relationship, include details on separate sheet): Name Address Phone No. 2. Licensed Land Surveyor or Engineer: 3. Location of Proposed Subdivision (tax map # and street address): 4. Easements or other restrictions on property (describe generally): 5. Names of abutting owners and owners directly across adjoining streets/roads (include those in other towns): 6. The undersigned hereby requests approval by the Town of Ira Planning Board of the above identified minor subdivision plat. Signature Title Date Revised October 2007