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I (We), the undersigned, do hereby make application (City of Hickory)

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City of Hickory – Preliminary subdivision Approval
Page 1 of 5
DATE SUBMITTED: _________________
I (We), the undersigned, do hereby make application to subdivide property located within the
planning jurisdiction of the City of Hickory.
1. The property to be subdivided is located on _____________________________ between
_________________________ and ________________________________.
PIN NO. (S):_________________________________________________________
Physical (Street) Address: _______________________________________________
2. The property is owned by: (please print)____________________________________
(Attach a copy of the most recent deed, contract for purchase or other legal interest
demonstrating an interest in the property.)
Owner Information:
Name: _______________________________________________
Address: ____________________________________________________________
Phone Number: _______________________________________________________
Fax Number: ___________________ Email: _______________________________
3. The application is submitted by: _________________________________________
(If the application is submitted by someone other than the owner proper authorization
from the property owner is required.)
Agent Information:
Name: _______________________________________________
Address: ____________________________________________________________
Phone Number: ______________________________________
Fax Number: ___________________ Email: _______________________________
4. The subject property is located in the ________________________ Zoning District.
5. It is proposed the property will be put to the following use: ____________________.
CITY OF HICKORY
APPLICATION FOR PRELIMINARY SUBDIVISION
(MAJOR SUBDIVISIONS)
City of Hickory – Preliminary subdivision Approval
Page 2 of 5
6. How has the property been used in the past? ________________________________.
7.
Plans/ Plats (20 copies, 8 of which must of full construction drawings). Digital plans may be
submitted; however, 8 paper copies of the full construction drawing must be provided.
Plans must include the following:
Location, widths and lengths of streets, alleys, vehicular use areas, etc:
Number and size of all proposed lots (lots must be numbered);
Dimensions of all lots, rights-of-way, common open space, etc;
Location, size and type of utilities proposed/ required within the subdivision;
Location and size of proposed / required common open space;
Location, size and type of stormwater control structures and/or measures;
Total area of the property proposed for subdivision;
Location of all fire hydrants;
Location of flood hazard areas;
Major physical features including wetlands, rivers / creeks, drainage ways, etc;
Location of existing structures;
Location map depicting location of property in relation to adjacent roadways;
Current zoning designation;
Location, size and type of proposed signage;
Location and details of community swimming pools, tennis court, or similar
amenities; and
Location of proposed / required sidewalks, trails and/or bikeways.
Note 1: The above list of items is not intended to be an all-inclusive list of
information needed to fully review proposals for property subdivision. Additional
information may be needed and I or requested as needed.
Note 2: All plans, plat, and construction drawings must be prepared in compliance
with the City of Hickory's Engineering Manual of Practice.
Note 3: The application for approval of a preliminary plat shall be accompanied by a
fee according to the City’s annually adopted fee schedule.
City of Hickory – Preliminary subdivision Approval
Page 3 of 5
8. OWNER’S AFFIDAVIT
We, the undersigned owner(s), hereby certify that the information contained herein and submitted in
support of this application is true and correct.
________________________________ ______________________________________
Printed Name of Owner Signature of Owner
(Please choose the appropriate notary block)
State of North Carolina – County of __________________
I, the undersigned Notary Public of the County and State aforesaid, certify that
_________________________________ personally appeared before me this day and acknowledged the
due execution of this foregoing instrument for the purposes expressed herein. Witness my hand and
Notarial stamp or seal, this _________ day of _____________, 20____.
My Commission Expires: ___________________ _____________________________
Notary Public
State of North Carolina – County of __________________
I, the undersigned Notary Public of the County and State aforesaid, certify that
__________________________________ personally came before me this day an acknowledged the he /
she is the ___________________________ of __________________________________ corporation /
limited liability corporation / general partnership / limited partnership (strike through the inapplicable),
and that by authority duly given and as the act of such entity he /she signed the foregoing instrument in
its mane on its behalf as its act and deed. Witness my hand and Notarial stamp or seal, this
____________ day of _________________, 20_____.
My Commission Expires: ___________________ _____________________________
Notary Public
City of Hickory – Preliminary subdivision Approval
Page 4 of 5
The application for approval of a preliminary plat shall be submitted to the Planning and Zoning
Administrator. The application shall be accompanied by copies of the preliminary plat which shall
contain the following information. Please review this list and mark any items you know are not shown
on the plat you are submitting. Marking this list will expedite the review process. If an item does not
apply to your property, please indicate by marking that item N/A. Plats cannot be approved until all
required information is provided.
1. Subdivision name
2. Name and address of land owner(s)
3. Name and address of owner’s agent, if any
4. Name, address, North Carolina registration numbers and seals of surveyor and
engineer
5. Location map showing subdivision in relation to major roads or other
obvious references
6. Date
7. Tax map, block and lot number(s)
8. Zoning classification of property and adjoining properties
1. North arrow
2. Scale - no smaller than 1” = 200’ shown graphically
3. Courses and distances of the perimeter of the land proposed for platting,
based on field survey
4. Total acreage of land proposed for platting
5. Identification of all land lying within the 100 year flood plain
6. Major physical features of site, including existing wetlands, drainage ways
and
existing structures
7. Names of owners of adjacent properties, names of adjacent subdivisions and
identification of publicly owned land
8. Names, rights-of-way widths and pavement widths of all adjacent public
streets
9. Location and use of all existing and proposed easements
10. Location, widths of rights-of-way and paving, and the names of all
proposed streets. Typical cross sections shown graphically.
11. Dimensions of all lot lines
CITY OF HICKORY
PRELIMINARY PLAT APPLICATION REQUIREMENTS
GENERAL
INFORMATION
SITE INFORMATION
City of Hickory – Preliminary subdivision Approval
Page 5 of 5
12. Location of all utilities installations
13. Engineering calculations indicating proposed fire flow rates and proposed hydrant
locations. Distance to nearest existing water main and hydrant shown.
14. Any sites proposed to be dedicated or reserved for public purposes
15. Direction of surface water flow on each street and ditch
16. Where a community water system (at least 15 service connections or 25
year
round residents) is proposed, a letter of approval from either the County
Health Department or the North Carolina Department of Health Services. The
County Health Department approves individual wells and non-community water
systems.
17. Where individual sewage disposal systems are proposed, a letter from the
appropriate county health department giving notification of percolation test results
and which proposed lots do not meet their standards. The health department may
require larger lot sizes. Generally, a copy of the plat will be forwarded to the
health department for their review by the City of Hickory.
18. Where package sewage treatment plants are proposed, a letter of approval from
the Water Quality Division of the Department of Natural Resources and
Community Development
19. Street plans and profiles showing existing and proposed grades and storm
drainage facilities. (With approval of SRB, street plans and profiles may be
submitted for approval following rough grading.)
20. Minimum building setback lines
21. Copy of proposed restrictions or covenants (submission is optional)
22. Proposed subdivision sign location(s)
23. Erosion and sedimentation control plan approval (may be submitted
following review and prior to initiation of grading)
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I (We), the undersigned, do hereby make application (City of Hickory)

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Completed 17 February 2021

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