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2. *DEPARTMENT USE ONLY

   CPC Case No:___________________________

   DATE ISSUED:_________________________

6. APPLICATION DATE:*
   APPLICATION DATE:
8. Name of Subdivision:*
10. Applicant Name:*
12. Applicant Address:
13. Applicant Address2:
15. City
16. State
17. Zip
19. Applicant Phone No:
20. Applicant Email:
22. Surveyor Name:*
24. Surveyor's Address:
26. Surveyor's Phone No:
27. Surveyor's Email:
29. Engineer's Name:
31. Engineer's Address:
33. Engineer's Number:
34. Engineer's email:
36. Subdivision Plat Summary:
38. (A) Total Area:
39. (B) Area In Lots:
40. (C) Area in Streets:
42. (D) Lineal Feet of Streets:
43. (E) Area Dedicated for Public Sites & Open Spaces:
44. (F) Number of Proposed Lots:
46. List of Materials Listed:
48. (A) Master Utility Plans:

    Number of copies.

49. Preliminary Plats:

    Number of copies

51. Size of Meter Requested:
52. Fire:
53. Application Fee $:
55. Other:
59. Signature: *
60. DATE:*
    DATE:
64. *OFFICE USE ONLY
66. Meeting date:_______________
68. Action of Planning Commission:

    _________________________________________________________________________________________________

    _________________________________________________________________________________________________

    _________________________________________________________________________________________________

    _________________________________________________________________________________________________

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71. 1. Receive an email copy of this form.
72. Email address

    This field is not part of the form submission.

73. Submit

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