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Plat Amendment Application Revised 3/6/2017 Page 1 Plat Amendment Application 101 N. 4th Street / P. O. Box 1030 Douglas, Wyoming 82633 307‐358‐2132, Fax: 307‐358‐2133 PROOF OF OWNERSHIP MUST ACCOMPANY THIS APPLICATION ORIGINAL LOT INFORMATION: 1) OWNER: Name Mailing Address City State Zip Telephone Email 2) PROPERTY: Address Current Legal Description: Subdivision: Lot Numbers: Block Numbers 3) CURRENT ZONING OF PROPERTY: 4) LOCATED IN A FLOOD ZONE: Yes No PROPOSED LEGAL DESCRIPTION: Subdivision: Lot Numbers: Block Numbers Property Owner Signature Date MINOR PLAT AMENDMENT Fee: $75.00 plus County recording fees Copy Fees: $12.00 for first page, $3.00 per page thereafter Received By: Receipt Date: Approved Disapproved Date: Date Filed with County: MAJOR PLAT AMENDMENT Fee: $125.00 plus County recording fees Copy Fees: $12.00 for first page, $3.00 per page thereafter Received By: Receipt Date: Approved Disapproved Date: Date Filed with County: SIGN