Application No. ________________
HENDERSON COUNTY
SUBDIVISION APPLICATION FORM
(Please fill out all
applicable items)
SUBDIVISION INFORMATION
Subdivision Name: ____________________________________________________________________________________
Subdivision Type (Circle One): Major Minor Non-Standard Special
Proposed Use of Property (Circle One): Residential Commercial Industrial
Conservation Subdivision: Yes No Gated entrance to property: Yes No
Existing Number of Lots: _________________________ Total Number of Proposed Lots: __________________________
Total Number Proposed Units: _____________________ Proposed Density (units per acre): _________________________
Road System: ( ) Public ( ) Private ( ) Combination Public and Private
Water System: ( ) Individual ( ) Community ( ) Municipal
Sewer System: ( ) Individual ( ) Community ( ) Municipal
PARCEL INFORMATION
PIN: _________________________Total Acreage: ___________Deed Book/Page: __________Township_____________
Location of property to be divided: _______________________________________________________________________
____________________________________________________________________________________________________
Zoning District: ______________________________________ Fire District: ___________________________________
Water Supply Watershed: ______________________________ School District: _________________________________
Any portion of property within or containing the following:
Floodplain or floodway: Yes No Perennial streams: Yes No
Protected mountain ridges: Yes No Cemetery: Yes No
Within ½ mile of a Farmland Preservation District: Yes No
Adjacent to a Farmland Preservation District: Yes No
CONTACT INFORMATION
Property Owner:
Name: ____________________________ Phone: _______________________________________________
Address: __________________________ City, State, Zip: ________________________________________
Applicant:
Name: ____________________________ Phone: _______________________________________________
Address: __________________________ City, State, Zip: ________________________________________
Agent: Agent Form (Circle One): Yes No
Name: ____________________________ Phone: _______________________________________________
Address: __________________________ City, State, Zip: ________________________________________
Plan Preparer:
Name: ____________________________ Phone: _______________________________________________
Address: __________________________ City, State, Zip: _________________________________ ______
I certify that the information shown above is true and accurate and is in conformance with the Subdivision regulations of
Henderson County.
__________________________ _______________________________ ___________
Print Applicant (Owner or Agent ) Signature Applicant (Owner or Agent ) Date
County Use Only
Fee: $_________ Paid: __________ Method: _________ Final Plat Approved On: ______________
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