eated 04/14/2005
CITY of
REPUBLIC
Established 1871
PLANNING AND DEVELOPMENT DEPARTMENT
225 North Main
Republic, Missouri 65738-1472
Phone: (417) 732-3354
Fax: (417) 732-2269
EASEMENT VACATION APPLICATION
(A Processing Fee of $50.00 is due at the time
application is made.)
FEE & CODE:
DATE & INITIALS:
RECEIPT NUMBER:
PUBLIC NOTICE DATE:
PUBLIC HEARING DATE:
BOARD OF ALDERMEN DATES:
1
ST
READING AT 7:00 PM
2
ND
READING AT 7:00 PM
APPROVED DENIED
FOR OFFICE USE ONLY
Applicant Name (Please Print):
Applicant Address:
Phone Number:
Fax Number: Email:
Applicant requests an easement vacation be approved for the following legally described property:
Street Address:
THE FOLLOWING INFORMATION SHOULD BE INCLUDED:
¾ Please attach a copy of the EASEMENT and proof of property ownership.
¾ Please include a list of all property owners subject to the easement that is proposed to be vacated.
¾ Please include the legal description for the easement to be vacated.
Purpose or reason for easement vacation:
PROPERTY OWNER/AGENT INFORMATION
Owner’s Name (Please Print):
Owner’s Address:
Phone Number:
Fax Number: Email:
Owner’s Signature:
Agent’s Name (Please Print):
Agent’s Address:
Phone Number:
Fax Number: Email:
Agent’s Signature:
Processing Fee: $50.00 Paid
□ Cash □ Check □ Check #
Y:\NEW\Public Works\Forms\Easement Vacation Application.doc
Cr
