Preliminary Plat Application
Ford County Planning, Zoning and Environmental Health
100 Gunsmoke
Dodge City, Kansas 67801
Phone: (620) 227-4670
Fax: (620) 227-4717
http://www.fordcounty.net

Owner Information
 Applicant/Agent/Surveyor Information(if Different)
Name:

Name:
Address:

Address:
Telephone: Telephone:
Email: Email:
Subdivision Name:
Minimum Lot Area:
Minimum Lot Front:
Proposed Zoning:                                                    Current Zoning:
_______Residential _______Commercial _______Industrial ______Other     /       Floodplain Zone:

Water & sewer Supply:
Public water district: __________________________________
Public sewer district: __________________________________
Private waste system on which lots: ___________________________
Engineered system required on which lots: _________________________

Street Standard:
Current             Plans to Improve
________         ________      Urban (asphalt w/curb & gutter)
________        _________    Suburban (asphalt)
________        _________    Rural Growth area (double chip & seal)

Additional right-of-way required for existing streets or proposed new streets? (enter "proposed" or "right-of-way" below)

                                          Street Name                       Feet                      Improvement? (urban,suburban,or rural

                                     _________________________            __________            ______________________________________

____________          _________________________           __________            ______________________________________

The owner herein agrees to comply with the requirements of the Subdivision Regulations for Ford County, as amended, and all other pertinent resolutions and regulations of Ford County, and Statutes of the State of Kansas. It is agreed that all costs of recording the plat and supplemental document thereto with the register of deeds shall be assumed and paid by the owner. The undersigned further states that he is the owner of the property proposed for platting.

___________________________________                                                      ______________________________________
Owner                                                                                           Date
_______________________________                                        _________________________________
Owner/Authorized Agent (if any)                                                    Date

OFFICE USE ONLY:
           This application was received at the office of the Zoning Administrator at _______(AM,PM) on _____day of _______,20___.
           It has been reviewed and found to be complete and accompanied by the required documents and the appropriate fee of ______.

___________________________________                                               _______________________________________
Name                                                                                                                       Title