Appendix 1C. APPLICATION FOR PRELIMINARY/FINAL PLAT

City of Bessemer

Application for Preliminary or Final Plat

DATE: ____________

Name of Subdivision ____________ ____________

Applicant Name ____________ Phone Number ____________ / ____________ / ____________

Address ____________ City ____________ State ____________ Zip Code ____________

Owner of Record ____________ Phone Number ____________ / ____________ / ____________

Address ____________ City ____________ State ____________ Zip Code ____________

Engineer ____________ Phone Number ____________ / ____________ / ____________

Address ____________ City ____________ State ____________ Zip Code ____________

Land Surveyor ____________ Phone Number ____________ / ____________ / ____________

Address ____________ City ____________ State ____________ Zip Code ____________

Attorney ____________ Phone Number ____________ / ____________ / ____________

Address ____________ City ____________ State ____________ Zip Code ____________

Subdivision located on the ____________ Side of ____________ feet ____________ of ____________

(Left, Right) (Street) (Direction) (Street)

Total Acreage ____________ Number of Lots ____________

Legal Description of Subdivision ____________ ¼ of ____________ ¼ of Section ____________ Township ____________ Range ____________ □ Attached Legal

Parcel Identification Number: ____________ □ Attached Tax Map

Present Zoning: ____________ Will the property require rezoning: ____________ Proposed Zoning: ____________

Attach Utility Availability Letters: □ Water □ Sewer □ Power □ Phone

Type of Bonding Required for Public Improvements: ____________

□ Attached five (5) copies of the proposed vicinity sketch map and preliminary sketch plan or final 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 ____________