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1700 South 10th St. • Noblesville, IN 46060 • ph. [PHONE REDACTED] • fax [PHONE REDACTED] • [EMAIL REDACTED] Developer Information Company Name: Address: City: State: ZIP: Phone Fax#: email: Contact Person: Title: Project Information Project Name: Section(s): Adjoining road name: Hamilton County Map Grid: Nearest Intersection: Number of Lots: Number of road miles: Will sewers be regulated? YES NO UNKNOWN Planning jurisdiction of project: Township: Is this a new project?: YES NO If NO, enter HCHD Project Type of Review(s) Requested Determination of Jurisdiction Review No Fee Primary Plat Review $400 x of sections) = Secondary Plat Review $400 x of sections) = Construction Plan Review $500 x of sections) = Small lots) Subdivision Review $100 x of sections) = (combined Primary & Secondary plat with no new roads) Variance Review $100 x of sections) = Total Fee Signature of Applicant: Date: Printed Name and Title: Note: 1. All Correspondence regarding this project should reference the HCHD project # (except initial application) 2. Make check or money order payable to the “Hamilton County Treasurer” (cash not accepted) 3. Submit fees, applications, plans and / or plat to: Hamilton County Highway Department ATTN: Staff Engineer 1700 South 10th St. Noblesville, IN 46060 4. All sections of this must be completely filled out and fee paid for reveiw to be made. FOR OFFICE USE ONLY RECEIVED DATE Check: Receipt Reviewed By: Review Date: Engineer / Surveyor / Architect Information Company Name: Address: City: State: ZIP: Phone Fax#: email: Contact Person: Title: $ 0 $ 0 $ 0 $ 0 $ 0 $ 0