Case # ________________ Received:

WARREN TOWNSHIP PLANNING BOARD

APPLICATION FOR MINOR SUBDIVISION

Application is hereby made for minor subdivision to be located in the ______________________________zone(s).

1. Applicant’s Name ______________________________________Phone _____________ Fax:_____________

Address __________________________________________________________________________________

2. Owner’s Name ________________________________________Phone ______________ Fax:____________

Address __________________________________________________________________________________

3. Attorney’s Name: ______________________________________Phone ______________Fax: _____________

Firm and Address __________________________________________________________________________

4. Name and address of person preparing plans _________Phone ________________Fax: ________________

Profession

Name _____________________________________________________________________________________

Address __________________________________________________________________________________

5. Location of Subdivision _____________________________________________________________________

(STREET NUMBER AND NAME)

__________________________________________________________________________________________

(TAX MAP BLOCK) (LOT NUMBER(S)) (TOTAL AREA OF ACREAGE)

6. Number of Proposed lots ____________________________________________________________________

7. List any zoning variance(s) required and if so, in addition, attach hereto as a separate rider your factual basis and legal theory for relief sought:

__________________________________________________________________________________________

__________________________________________________________________________________________

8. Deed restrictions that apply or are contemplated (if no restrictions, state “NONE”, if “YES” attach

copy:

__________________________________________________________________________________________

9. Development plans _________________________________________________________________________

a. Sell lots only? (yes or no) ___________ Construction of houses for sale: (yes or no) _______________

b. Other __________________________________________________________________________________

REVISED 1-1-93; 7-16-97; 6/3/2010

PLANNING BOARD APPLICATION FOR MINOR SUBDIVISION PAGE TWO OF TWO

10. Briefly describe any prior or presently pending proceedings before the Warren Township Planning Board or any other federal, state, or local board or agency involving the property which is the subject of this application.

__________________________________________________________________________________________

__________________________________________________________________________________________

11. List any other material accompanying this application, i.e. plans, drainage calculations, etc..

__________________________________________________________________________________________

__________________________________________________________________________________________

___________________________________________________

Applicant’s Signature Date

CONSENT OF OWNER IF OTHER THAN APPLICANT

I, THE UNDERSIGNED, BEING THE OWNER OF THE LOT OR TRACT DESCRIBED IN THE FOREGOING APPLICATION, HEREBY CONSENT TO THE MAKING OF THIS APPLICATION AND THE APPROVAL OF THE PLANS SUBMITTED HEREWITH.

DATE ____________________________________ __________________________________________

Owner

WITNESS: ________________________________ __________________________________________

Owner

__________________________________________

Owner

Revised 1-1-93;7-16-97; 6/3/2010