File #: ______________________
Today's Date:
Owner's Name:
Mailing Address:
Home Phone Number: Cell Phone Number:
Engineer/Land Surveyor:
Engineer/Land Surveyor Mailing Address:
Engineer/Land Surveyor Telephone:
Address/Common Name of Proposed Replat:
Legal Description ( Section, Township, Range):
Distance to Nearest Incorporated City or Town:
(If any part of the subdivision lies within one (1) mile of the boundary of an incorporated city/town, the approval
of the governing body of the city/town must also be obtained in accordance with Wyoming State Statutes
Size of Replatted Land: Number of Lots/Blocks/Tracts:
Size of Lot: Minimum: Maximum:
Present Zoning:
Proposed Zoning:
CUP or Variance:
Present Land Use:
Proposed Land Use:
Print Form
Ultimate Land Use Plan:
Water Service: Private Public
Name of Utility Providing Public Water:
Sewer Service: Private Public
Name of Utility Providing Public Water:
Proposed Method of Road Maintenance and Solid Waste Disposal:
Provide the following: Proof of Ownership, Covenants and Restrictions, Copy of All Existing Final Plats
(Blue Line Print)
Reason you want to replat:
Applicant Signature: ___________________________________________ Date: ____________________
Land Owner Signature: _________________________________________ Date: ____________________
Filing Fee Received:____________________
Final Replat:____________________
Date Recorded:____________________
Erosion Control Plan:____________________