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Re: Date: APPLICATION FOR SUBDIVISION REVIEW Pre-application documentation must be satisfactorily completed and submitted prior to any application for a subdivision review. Name of Name of Property Physical Address: Mailing Address: Work Phone Name of *Agent: ('Completed and notarized agent authorization form required.) Physical Address: Mailing Address: Work Phone Cellphone Name of Developer: Physical Address: Mailing Address: Work Phone Name of State Physical Address: Mailing Address: Work Phone Cellphone Total Project Acres: Total Number of Residential Lots: Mean Lot Size 10.) Total Number Of Lots/Parcels/Areas Assigned To: Storm Water Detention. Recreation. THOMSON - MCDUFFIE COUNTY PLANNING COMMISSION 210 RAILROAD STREET, SUITE 1544, THOMSON, GEORGIA 30824 (706) 595-5355 [EMAIL REDACTED] ---PAGE BREAK--- Green Space. Other: 11.) Total Road Frontage: 12.) Mean Frontage/Lots (estimated): 13.) Current Use of Property: 14.) Currently Zoned: Future Land Use Designation: 15.) Anticipated Zoning: 16.) Based on the above zoning classification(s), the following structure uses would be permitted: 17.) Anticipated Construction Starting 18.) Will development be phased? [ ] No [ ] Yes, list anticipated starting and completion dates for each phase. [ ] No, this project will be 100% constructed. 19.) Will more than "one application" be involved? For example, in addition to the subdivision review, will there be an application for a zoning change or variance? [ ] No [ ] Yes - List Applications 20.) Are any of the following environmental issues present or "involved" with the property or project. [ ] Yes [ ] No Wetlands [ ] Yes [ ] No FEMA Floodplains [ ] Yes [ ] No State Waters 21.) Other than the required basic standard improvements for a subdivision such as paved roadways, signage, drainage facilities, etc. - what other infrastructure or amenities will be incorporated into the subdivision development. [ ] Yes [ ] No Municipal [ ] Yes [ ] No Municipal [ ] Yes [ ] No Municipal [ ] Yes [ ] No Special purpose easements: [ ] Yes [ ] No Raised concrete curb and [ ] Yes [ ] No Buried storm water [ ] Yes [ ] No Sidewalks [ ] Yes [ ] No Green Space [ ] Yes [ ] No Greenways [ ] Yes [ ] No Outdoor recreation areas [ ] Yes [ ] No Indoor recreation facility - Clubhouse [ ] Yes [ ] No Street Lighting [ ] Yes [ ] No Buried electrical services [ ] Yes [ ] No Guard gate or other security services [ ] Yes [ ] No Landscaping — Entrance — Roadways - Other [ ] Yes [ ] No Dumpster placement/service [ ] Yes [ ] No Subdivision Covenants [ ] Yes [ ] No Homeowners Association [ ] Yes [ ] No Other: Application Fee Received: Date: ---PAGE BREAK--- As witnessed by applicant /agent’s signature (below), applicant/agent does hereby agree to and fully understands that: The submitting of false information by any means to the Planning Commission related to this application shall constitute grounds for denial of same and revocation of any applicable permits. Should the final subdivision review be denied or conditionally approved, the applicant has a right to appeal the Planning Commission Board's decision to the Thomson City Council at its next regularly scheduled meeting Any contact by the applicant, related party or person with any member of the Planning Commission Board concerning any aspect of this application will be considered as prejudicial to his or her application. Intentional disregard of this restriction may result in automatic denied of the application. I HEREBY WARRANT AS WITNESSED BY MY SIGNATURE BELOW THAT, UNDER PENALTY OF PERJURY, ALL OF THE STATEMENTS CONTAINED HEREIN OR SUBMITTED WITH THIS APPLICATION ARE TRUE TO THE BEST OF MY KNOWLEDGE AND THAT I FULLY UNDERSTAND ALL STATEMENTS CONTAINED IN THIS APPLICATION (Applicant's Signature) (Date) Office Use Anticipated Planning Commission Meeting Date: Anticipated City Council Meeting Date: Decision: Notes: