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OTSEGO COUNTY LAND USE SERVICES 225 W MAIN ST. GAYLORD MI 49735 PHONE: [PHONE REDACTED] * FAX: [PHONE REDACTED] www.otsegocountymi.gov APPLICATION FOR PARCEL DIVISION APPLICANT INFORMATION: Name: Address: City: State: Zip Code: Phone: Fax: PROPERTY OWNER INFORMATION: Name: Address: City: State: Zip Code: Phone: Fax: PROPERTY LOCATION: Address: Parent Parcel Number: Township: T N/R W Section: DIVISION INFORMATION: 1. Zoning of Parent Parcel: 2. Size of Parent Parcel after Split: Width: Depth: Area: 3. Size of Proposed Split: Width: Depth: Area: 4. Number of Divisions Granted to New Parcel: 5. Adequate Permanent Access to New Parcel is provided by: a) Frontage on an existing road: b) Creation of a new public road: c) Creation of a new private road or access easement: 6. Development Parcel Limits: (Check all that apply) □ Wetlands: □ River or Lakefront: □ Flood plain: □ Slopes of more than 25%: Is known or suspected to have an abandoned well, storage tank, or contaminated soils: ***NOTE: Section 109(A) Divisions less than one acre shall not have a building permit issued unless the site has Health Department approval for on-site water supply and sewage disposal, unless public water and sewer are available (as indicated on map/survey supplied). Section 109 The municipality and employees approving divisions of less than one acre are not liable if a building permit is not issued for the reasons set forth in this section. ---PAGE BREAK--- REQUIRED ATTACHMENTS: (All attachments must be included) 1. Signed, sealed survey map (according to Section 21.14.3 of the Zoning Ordinance) drawn to scale of the parent parcel as of MARCH 31, 1997, which includes: the proposed new parcel(s) all previous divisions after March 31, 1997 means of access utility easement to the new parcel from existing utilities any existing improvements any features indicated in the "Development Parcel Limits" 2. Approval or permit from Otsego Country Road Commission or MDOT for the proposed road, easement or driveway. 3. A copy of the deed, land contract, and/or lease, showing the date the Parent Parcel was created. 4. Tax certification for Parent Parcel – Additional fees apply 5. Legal descriptions of new Parent Parcel and new Parcel(s). Affidavit and permission for township, county and state officials to enter the property for inspection of proposed division: I agree that statements made in this application are true and if found not to be true, this application and any approval will be void. Further, I agree to comply with the conditions and regulations provided with this parent parcel division. Further, I agree to give permission for officials of the township, county and state to enter the property where this parcel division is proposed for the purposes of inspection. Further, I understand this is only a parcel division, which conveys only certain rights under the applicable local land division ordinance and the State Land Division Act [(formerly the Subdivision Control Act, P. A. 288 of 1967), as amended (particularly by P.A. 591 of 1996), MCL 560.101 et. seq.] and does not include any representations or conveyance of rights in any other statute, building code, zoning ordinance, deed restriction or other property rights. Finally, even if this division is approved, I understand zoning, local ordinances, and State Acts change from time to time. If changed, the division made here must comply with the new requirements (apply for division approval again) unless deeds, land contracts, or long-term leases (30 years or more) are recorded with the Register of Deeds or the division is built upon before the changes to laws are made. Property Owner(s) Signature Applicant(s) Signature ***OFFICE USE ONLY*** DO NOT WRITE BELOW THIS LINE Date Received: Approved: Denied: Conditions (if any): Reasons: Signature: Date: