DATE: ________________________________

SUBDIVISION NAME: _____________________________________________________________________

APPLICANT NAME/CONSULTANT FIRM: ___________________________________________________

_____ 1. Proposed Subdivision Name

_____ 2. Tax Map and Lot Number of Proposed Subdivision

_____ 3. Field Survey of boundary lines of tract of land

_____ 4. Copy of deed and any existing covenants affecting property

_____ 5. Proposed covenants and deed restrictions

_____ 6. Type of sewage disposal

_____ 7. Test Pit Data

_____ 8. Type of water supply

_____ 9. Date plan prepared

_____ 10. Magnetic North

_____ 11. Graphic Map Scale

_____ 12. Name and address of record owner, sub-divider and individual or company who prepared plan

_____ 13. Names and addresses of adjoining property owners

_____ 14. Location of Zoning Boundaries affecting subdivision

_____ 15. County Soil Survey

_____ ` 16. Contour lines as specified by Planning Board

_____ 17. Location and elevation of 100 year floodplain

_____ 18. Soil erosion and sedimentation control plan

_____ 19. Drainage Plan

_____ 20. Location of fresh water wetlands

_____ 21. Location of rivers, streams or brooks within or adjacent to proposed subdivision

_____ 22. Location of significant wildlife habitat

_____ 23. Location of watershed of lake or pond

_____ 24. Phosphorus impact analysis

_____ 25. Statement of technical and financial capacity

_____ 26. Evidence of right, title or interest in the property to be reviewed

_____ 27. Subdivision Fees Paid

_____ 28. Statement that Fire, Rescue, Road Commissioner and Superintendent of Schools have received copies of the proposal

_____ 29. Certification of Compliance from Code Enforcement Officer

DATE: _________________________________________________

PROPOSED SUBDIVISION NAME: __________________________________________________________

APPLICANT/CONSULTANT:_________________________________________________________________________________________________________________________________________________________

_____ 1. Proposed Subdivision Name

_____ 2. Tax Map and Lot Number where Subdivision is proposed to be located

_____ 3. Field survey of boundary lines of tract of land

_____ 4. Copy of deed and existing covenants, if any affecting property

_____ 5. Proposed covenants and deed restrictions for project

_____ 6. Contour lines as specified by the Planning Board

_____ 7. Number of acres in proposed subdivision

_____ 8. Location of property lines

_____ 9. Water courses

_____ 10. Vegetative cover if any

_____ 11. Type of sewage disposal proposed

_____ 12. Test pit data

_____ 13. Location of test pits

_____ 14. Type of proposed water supply

_____ 15. Date Plan prepared

_____ 16. Magnetic North

_____ 17. Graphic Map Scale

_____ 18. Name and address of record owner, sub divider and individual or company who prepared plan

_____ 19. Names and addresses of adjoining property owners

_____ 20. Location of Zoning Boundaries affecting Subidivsion

_____ 21. Location and size of existing and proposed sewer, water mains, culverts and drainage ways on or adjacent to the property to be subdivided

_____ 22. Location, names and widths of existing and proposed streets, easements and open space on or adjacent to the subdivision

_____ 23. Proposed lot lines with appropriate dimensions and lot area

_____ 24. Location and conditions of land proposed for public use, if any

_____ 25. Location of open space to be preserved and its proposed management

_____ 26. Soil erosion and sedimentation plan

_____ 27. Drainage plan

_____ 28. Medium intensity soil survey

_____ 29. Location of 100 year floodplain

_____ 30. Location of wetlands

_____ 31. Location of rivers, streams or brooks within or adjacent to subdivision

_____ 32. Location of significant wildlife habitat if any

_____ 33. Location of watershed of lake or pond

_____ 34. Phosphorus impact analysis

_____ 35. Statement of technical and financial capacity

_____ 36. Evidence of right, title or interest in the property proposed for subdivision

_____ 37. Evidence that Subdivision fee has been paid

_____ 38. Statement that Fire, Rescue, Road Commissioner and Superintendent of Schools have all received copies of the proposed plan

_____ 39. Certification of Compliance from Code Enforcement Officer

_____ 40. Location of archaeological sites, if any

_____ 41. Rare and endangered species

_____ 42. Historic buildings and/or sites located, if any

_____ 43. Location of any scenic vistas as identified in Comprehensive Plan

_____ 44. Traffic impact analysis

R10/2003