DAWSON COUNTY

PRELIMINARY SUBDIVISION PLAT APPLICATION FORM

1. Name, address, and telephone number of landowner and representative, if any (e.g.: engineer, surveyor)

_______________________________________________________________________________

2. Name of development, if any

3. Location

Legal Description

4. Descriptive Data:

a. Total area in acres

b. Number of lots or rental spaces

c. Minimum and maximum sizes of lots or spaces

Indicate the proposed use(s) and number of lots or spaces in each:

General description of proposed use(s)

Residential, single family

Residential, multiple family

Type of multiple family structures and numbers of each (e.g.: duplex, four-plex)

Planned Unit Development (No. of units )

Condominium (No. of units )

Recreational or Second Home

Mobile Home Park

Recreation Vehicle Park

Commercial or Industrial

Other (Pleas describe)

5. Physical Conditions:

Provide the following information regarding the development:

a. Current land use

b. Existing zoning or other regulations

c. Depth to ground water at time of year when water table is nearest the natural ground surface within the drainfield area

d. Depth to bedrock or other impervious material in the drainfield area

6. List of materials submitted with this application

a. Copies of preliminary plat

b. Vicinity sketch

c. Contour map

d.

e.

f.

g.

h.

I hereby affirm that all the statements and information contained herein and the statements and information contained in all exhibits transmitted herewith are true. I hereby apply to Dawson County for approval of the preliminary plat for Subdivision.

Subdivider or Agent

File: forms\DawsonCountycosapp