NAME OF APPLICANT _____________________________________________________

ADDRESS OF APPLICANT __________________________________________________

DAYTIME TELEPHONE NUMBER __________________________

LOCATION OF PROPOSED SUBDIVISION _____________________________________

WARD _______ PLATE ________ LOT/BLOCK __________ ZONING ___________

APPROXIMATE SIZE OF PROPERTY ______________________

NUMBER OF LOTS ___________ NUMBER OF LOTS TO BE CREATED ________

BRIEF DESCRIPTION OF PROPOSED SUBDIVISION ____________________________

__________________________________________________________________________

__________________________________________________________________________

PLANS PREPARED BY _____________________________________________________

DATE OF PLAN ____________________

No subdivision application will be accepted without six (6) copies of a survey completed by a registered surveyor. There is also a plan review fee of $25.00 per hour; the first hour of review is due upon application. Any review time exceeding the first hour will be billed upon completion of the process.

Any approved subdivisions will be required to be recorded at the Clinton County Courthouse. It will be the responsibility of the applicant to submit signed and completed plans to the County as well as returning a completed copy to the City Code/Zoning Office.

SIGNATURE ________________________________________________________________

(Indicate whether Owner or Authorized Agent)

1. DATE OF REVIEW BY ZONING OFFICER ________________

COMPLETED PLANS ___________ ITEMS NECESSARY TO COMPLETE PLANS ______

______________________________________________________________________________

2. DATE OF COMPLETED STAFF REVIEW (IF APPLICABLE) ______________________

COMMENTS/RECOMMENDATIONS:_____________________________________________

______________________________________________________________________________

______________________________________________________________________________

3. NECESSARY REVIEWS AND COMPLETED DATES:

PENN DOT _______________

DER_____________________

COUNTY CONSERVATION DISTRICT ________________

OTHER____________________

COMMENTS/RECOMMENDATIONS:_____________________________________________

______________________________________________________________________________

______________________________________________________________________________

4. DATE OF PLANNING COMMISSION MEETING FOR REVIEW _______________________

DECISION: APPROVED ___________ DENIED ON THE BASIS OF __________

______________________________________________________________________________

5. STIPULATIONS OR CONDITIONS OF APPROVAL __________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

6. DATE OF NOTIFICATION LETTER ______________________________

7. DATE OF PLAN RECORDING ___________________________________

8. ADDRESS ISSUED BY ENGINEER _______________________________

OFFICIAL SIGNATURE _________________________________________________________

DATE OF FILE COMPLETION ________________________