Case # __________
Received:
APPLICATION FOR PRELIMINARY MAJOR
SUBDIVISION
SITE NAME
___________________________________________________________
APPLICATION is hereby made for Preliminary
__________Amended ________ approval of a major subdivision to be located in the
____________zone(s).
1.
Applicant’s
Name ______________________________Phone ________________________
Fax: _____________________Street Address ____________________________________
Town, State, Zip:
____________________________________________________________
2.
Owner’s
Name ________________________________ Phone _______________________
Fax: ______________________ Street Address:
__________________________________
Town, State, Zip:
___________________________________________________________
3.
Attorney’s
Name _______________________Phone_____________Fax: ______________
Firm and Address
__________________________________________________________
4, Name of Person Preparing Plans _______ Phone _______________Fax:
______________
Profession
Name _______________________________Firm _________________________________
Address:
__________________________________________________________________
STREET, CITY, STATE, ZIP CODE
STREET
________________________________________________________________________
TAX MAP BLOCK
separate rider your
factual basis and legal theory for the relief sought.
________________________________________________________________________
________________________________________________________________________
Attach copy.) ____________
MAJOR PRELIMINARY SUBDIVISION
APPLICATION PAGE
2 0F 2
Board or any other federal, state, or local board or agency
involving the property which is the
subject of this application.
_____________________________________________________________________________
_____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
_____________________________________
Applicant’
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
___________________________________ ______________________________________
Date Owner
Revised
Revised
Revised