APPENDIX C
(amended to April 21, 2006, approved effective May 18, 2006)

PLANNING COMMISSION

CITY HALL

125 EAST AVENUE P.O. BOX 5125

NORWALK, CT 06856-5125

APPLICATION FOR APPROVAL OF SUBDIVISION OR RESUBDIVISION MAP

Application is hereby made to the City Planning Commission for approval of a Subdivision or Resubdivision map entitled:

______________________________________________________________________________

______________________________________________________________________________

  1. Name and address of persons submitting application: ____________________________

    2. ________________________________________________Telephone No. ___________

  2. Name and address of owner of record at time of submission of plans: ________________

    3. _________________________________________________Telephone No. __________

  3. Name and address of Engineer, Surveyor or Designer: ___________________________

    4. _________________________________________________Telephone No. __________

  4. Address of Property _______________________________________________________
  5. Tax District __________ Tax Block _________ Tax Lot __________ CAM_________
  6. Zoning Designation ______________ Plan of Development Designation ____________
  7. Total area of proposed subdivision or resubdivision: _______ No. of lots proposed _____
  8. Water Supply:
    9.

    a. Is public water available within or at periphery of proposed subdivision or resubdivision? ___________

    b. If not, how far distant is public water available, measured along a public right-of-way? _____________________________________________________________

    c. Is the public water system to be extended to serve proposed subdivision or resubdivision? __________________

  9. Sewage Disposal:

    10. a. Is public sewage system available within or at periphery of proposed subdivision or resubdivision? _________________

    b. If not, how far distant is public sewage available, measured along a public right-of-way? _________________

    c. Is the public sewage system to be extended to serve proposed subdivision or resubdivision? _______________

     

    -2-

    Subd. Application Cont.

  10. Streets:
    11.

    a. List names of existing streets and widths of right-of-way and traveled roadway within or adjacent to proposed subdivision or resubdivision _______________________________________________________________

    b. List names of proposed streets and lengths: ____________________________ ________________________________________________________________

    c. Can this application form be considered an offer of dedication to the City of Norwalk for public acceptance of the proposed streets contained in this subdivision or resubdivision upon proper completion thereof? _______________If not, please explain: __________________________________________________________________

    __________________________________________________________________

  11. Existing structures: Description: _____________________________________

    12. __________________________________________________________________

  12. Does owner of record own or have any interest in a partnership or corporation owning abutting property? _____________________________________________________
  13. Has the Zoning Board of Appeals granted any variances or permits concerning this property? __________ If so, full information must be attached. ____________________

    14. _______________________________________________________________________

  14. Is any variance from the "Subdivision/Resubdivision Regulations" requested? _________. If so, a letter stating reasons must be submitted herewith.

    15. RECORD OWNER(S) SIGNATURE

    ______________________________

    (If agent signs, a letter of

    authorization from the owner(s)

    must accompany this application).

    APPLICATION AND INSPECTION (to be filled in by Planning Commission Staff)

  15. Number of new building lots - including

    16. remainder of tract: LOTS X $200. = __________ + $30. State fee = ____________

  16. Minimum fee: $400. + $30.00 State fee: Total _______________________________

PAID TO: ____________________________

(Signature)

DATE:_______________________________

Deadline for application submittals: The applicant must submit all documentary evidence in support of the application to the Commission no fewer than ten (10) days prior to the day of the hearing or any reconvening thereof. (Amended to May 18, 2006)


Page 3 - List names and addresses of owners abutting and across the street from the property to be subdivided or resubdivided.

NORWALK PLANNING COMMISSION (This form is available at the Planning Commission)

Subd. Application Cont.

NORWALK PLANNING COMMISSION

CITY HALL

125 EAST AVENUE P.O. BOX 5125

NORWALK, CT 06856-5125

 

NAME: ____________________________________________________________

ADDRESS: ____________________________________________________________

CITY& STATE: ____________________________________________________________

D/B/L: ____________________________________________________________

NAME: ____________________________________________________________

ADDRESS: ____________________________________________________________

CITY& STATE: ____________________________________________________________

D/B/L: ____________________________________________________________

NAME: ____________________________________________________________

ADDRESS: ____________________________________________________________

CITY& STATE: ____________________________________________________________

D/B/L: ____________________________________________________________

NAME: ____________________________________________________________

ADDRESS: ____________________________________________________________

CITY& STATE: ____________________________________________________________

D/B/L: ____________________________________________________________

NAME: ____________________________________________________________

ADDRESS: ____________________________________________________________

CITY& STATE: ____________________________________________________________

D/B/L: ____________________________________________________________

NAME: ____________________________________________________________

ADDRESS: ____________________________________________________________

CITY& STATE: ____________________________________________________________

D/B/L: ____________________________________________________________

NAME: ____________________________________________________________

ADDRESS: ____________________________________________________________

CITY& STATE: ____________________________________________________________

D/B/L: ____________________________________________________________