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ZONING ADMINISTRATOR'S CHECKLIST FOR DISTRIBUTION OF PLATS FOR COUNTY <br /> (Numbered Items of this form to be filled out by the subdivider or agent) <br /> 1. Name of Subdivision: <br /> 2. Preliminary Plat ( ) Final Plat ( ) <br /> 3. The subdivision is located within the Town of <br /> & within the extraterritorial jurisdiction of <br /> (city or village) <br /> 4. The subdivision abuts or adjoins a state trunk highway Yes ( ) No ( ) . <br /> 5. The subdivision is served by public sewer Yes ( ) No ( ) . <br /> 6. The subdivision abuts a county park or parkway Yes ( ) No ( ) . <br /> 7. <br /> (Submitted by) (Signature) (Address) <br /> NO. OF COPIES <br /> TRANSMITTED <br /> CONDITIONS AFFECTING NO. OF COPIES (circle if TO BE SENT BY ZONING <br /> TO BE DISTRIBUTED applicable) ADMINISTRATOR TO: <br /> -Subdivision located in the 4 County Zoning Adm. Office <br /> Town of (see #3) 2 Town Clerk's Office <br /> -Subdivision located in the extraterritorial 2 City/Village Clerk's Office <br /> jurisdiction of (see # 3) <br /> -All plats 2 <br /> -Subdivision abuts or adjoins a state trunk Department of Agriculture, <br /> highway or connecting street 2 Trade and Consumer <br /> -Subdivision not served by public sewer and Protection <br /> no provision has been made. . 2 <br /> ALSO SEND COPIES TO: <br /> -Subdivision abuts county park or parkway. . <br /> -County Highway Department <br /> -Utilities <br /> -Other <br /> Total Number of Copies: <br /> Department of Industry, Labor <br /> & Human Relations forms & fee Number of copies sent DATCP <br /> DATCP submittal form, Fee <br /> Schedule & $ check . . . . <br /> I hereby certify that I am full time county administrator of planning legislation and <br /> zoning regulations. Enclosed are copies of this plat submitted by me as Clerk <br /> of the County Planning Agency. <br /> (Signature) County Zoning Adm. (Date) <br />