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FEE $50.00 PETITION FOR TAX PARCEL SEGREGATION FILE # RECEIPT # FILING DATE PLEASE COMPLETE THE APPLICATION CLEARLY AND ACCURATELY (Name of Owner/Applicant)(1st party) (Address) (Phone) General Location of Property: (give location relative to streets, intersections, etc.) SURVEY/PLAN REQUIRED: 6 copies of a site plan or survey drawn to scale including the following information Must be provided. The proposed parcel lines for all effected lots, indicated by heavy solid lines; The legal description(s) and parcel number(s) of the effected parcel(s); The location of all structures existing upon the effected parcel(s); The location and dimensions of any drain field, wellhead protection area, easement or right-of-way existing within or adjacent to any effected parcel(s); The area and dimensions of each parcel following the proposed segregation; The existing and, if applicable, proposed future method of sewage disposal for each affected parcel. Where any parcel effected by a proposed segregation is served or is likely to be served in the future by an on-site sewage disposal system, a percolation test for each such parcels may be required by the City Engineer when the City Engineer finds that the proposed segregation could adversely effect the ability of such parcel(s) to be adequately served by such on- site system. Print Form Submit by Email