Application Form
Town of
Subdivision Name______________________________
Application Number____________________________
Application
Information
Name of Property Owner: ___________________________________________________________
Address: ___________________________________________________________
Telephone (____) ________-_______________
If applicant is a corporation, check if licensed in Maine YES / NO and attach a copy of States Registration.
Name of Applicant’s authorized agent: _________________________________________________
Address: _______________________________________________
_______________________________________________
Telephone (______) ___________-____________________________
Name of Land Surveyor, Engineer, Architect or others preparing plan:
___________________________________________________
___________________________________________________
Address: ___________________________________________________
___________________________________________________
Telephone: (__________) ________-______Registration#_______________
Person and Address to which all correspondence regarding this application should be sent:
________________________________________________________________________________________________________________________________________________________________________________.
What legal interest does the applicant have in property to be developed (ownership, option, purchase and sales contract, ECT.)? ___________________________________________________________________________
What interest does the applicant have in any abutting property? ________________________________________________________________________________________________________________________________________________________________________
LAND INFORMATION
Location of property (street location) __________________________________________________________
(from
(from Tax Maps): Map ___________________________Lot(s) ______________
Current zoning of property: _________________________________________________________________
Is any portion of the property within 250 feet of the high water mark of a pond, river or salt water body?
________Yes_______No
Total Acreage of Parcel; _________________________________________________
Acreage to be developed: ________________________________________________
Indicate the nature of any restrictive covenants to be place in the deeds:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Has this land been part of a prior approved subdivision? _____________Yes_____NO
Or other divisions within the past 5 years? _____________Yes_____NO
Identify existing use(s) of land (farmland, woodlot, ect) ______________________________________________________________________________________________________________________________________________________________________
Does the parcel include any water bodies? ___________YES________________NO
Does the parcel include any wetlands? ___________YES________________NO
Is any portion of the property within a special flood hazard area as identified by the Federal Emergency Management Agency? ___________YES________________NO
List below the names and mailing addresses of abutting property owners across the road:
Name Address
________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
GENERAL INFORMATION
Proposed name of development: ______________________________________________________________
Number of lots or units: _____________________________________________________________________
Anticipated date for construction: _____________________________________________________________
Anticipated date of completion: ______________________________________________________________
Does this development require extension of public infrastructure? _____YES_____________NO
___________Roads ____________storm drainage _______________other: explain
___________sidewalks _________water lines ___________________________
___________sewer lines_________fire protection equipment ___________________________
Estimate cost for infrastructure $________________________________________
Identify method of water supply to the proposed development:
_______________individual wells
_______________central well with distribution lines
_______________connection to public water system.
_______________other, please state alternative
Identify method of sewage disposal to the proposed development:
_______________individual septic tanks
_______________central on site disposal with distribution lines
_______________connection to public sewer system
_______________other, please state alternative.
Identify method of fire protection for the proposed development:
_______________hydrants connected to the public water system
_______________dry hydrants located on an ex9ositing pond or water system
_______________existing fire pond
_______________other, please state alternative.
Does the applicant propose to dedicate to the public any streets, recreation or common lands?
Street(s) ________YES__________NO Estimated length_____________
Recreation area(s) ________YES__________NO Estimated Acreage___________
Common land(s) ________YES__________NO Estimated Acreage___________
Does the applicant intend to request waivers of any of the subdivision submission requirements?
If yes, list them and state reasons for the request.
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
To the best of my knowledge, all the above information submitted in this application is true and correct.
____________________________________________________ ____________________________
(signature of applicant) (date)
_______________________________ _________________________________________________
FEE COLLECTED By Whom