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4. Location of proposed Subdivision:
APPLICATION
~t U
FOR REVIEW AND APPROVAL OF PRELllVYINARY PLAT
r ~ ~
1. Name or ioentiiyingtitle of Subdivision
2.
SubdivIder: (if owner,
on B~parate shee
state details
Name
Address
Telephone
3.
Name
Address
· Telephone
5.
fasements or other
:~ i~f
ribegenerally) :
6.
Names of abutting owner~ . a
those_ i.n other ,cities):
"oining streets ( 4lclu~~. _____________ ______________
7.
Requested variances. The Planning Commission is requested to authorize the
following exceptions to its regulations governing subdivisions ith the reason (attach
list of such exceptions with the reason for each set forth):
".
8. The undersigned hereby requests approval by the Planning Commission of the above
identified subdivi ion plat.
--------------~---- -------------------------------~----~----
This will acknowledge receipt of dollar s ($, )
in payment of the fee for the above requested approval of applicant1 s preliminary plat..
Date
Signed
Title
las/S-12-.70
(Carbon to be retained by applicant)