Appendix 1B. APPLICATION FOR RESURVEY PLAT

City of Bessemer

Application for Resurvey Plat

Date ____________

Name of Subdivision ____________

Name of Applicant ____________

Owner of Record ____________

Surveyor ____________

Property Address ____________

Parcel Identification Number ____________

Previous Subdivision Name ____________

____________ ____________

Lot Numbers (Attach Plat Map of Original Subdivision)

Existing Parcel Zoning ____________

Name of Applicant ____________

Will The Property Require Rezoning? □ YES □ NO

Proposed Zoning ____________

Will Public Improvements be Required by Resurvey? □ YES □ NO

□ Attach five (5) copies of resurvey plat.

I, ____________ hereby depose and say that all the above statements and the statements contained in the papers submitted herewith are true.

Signature ____________ Title ____________

Address ____________ City ____________ State ____________ Zip Code ____________