Fill - Free fillable MINOR LAND DIVISIONS PERMIT APPLICATION PDF form

Yavapai County Development Services

Prescott Office

1120 Commerce Drive, Prescott, AZ 86305

(928) 771-3214 Fax: (928) 771-3432

Cottonwood Office

10 S. 6

th

Street, Cottonwood, AZ 86326

(928) 639-8151 Fax: (928) 639-8153

Addressing – Building Safety – Customer Service & Permitting – Environmental –Land Use – Planning

MINOR LAND DIVISIONS PERMIT APPLICATION

The following information is REQUIRED

Please print or type (no pencil)

CURRENT ASSESSOR’S PARCEL NUMBER __________--_______--___________

PROPERTY ADDRESS: ____________________________________________________________

OWNER

NAME ____________________________________

MAILING ADDRESS ____________________________________

____________________________________

PHONE _________________ FAX _________________________

E-MAIL _______________________________________________

APPLICANT

NAME ____________________________________

MAILING ADDRESS ____________________________________

____________________________________

PHONE __________________ FAX _________________________

E-MAIL ________________________________________________

CONTACT PERSON _____________________________________

PHONE __________________ FAX _________________________

E-MAIL ________________________________________________

Total Number of New Lots Being Created: 2 3 4 5 (For example: If 5 lots are being created from 1 lot, circle 5)

CERTIFICATION: Applicant hereby certifies that information contained in this application and

accompanying plans and documents is true and correct. The owner hereby acknowledges that a minor

land division permit application that does not comply with one or more of the items listed in Section

546C may still have a minor land division permit issued if the applicant signs and records an

acknowledgement that no building permit, zoning clearance or use permit will be issued until the lot,

parcel or fractional interest meets the minimum noted requirements.

Signature _________________________________________________________ Date ___________

(Applicant)

Comments

_________________________________________________________________________________

CLERK _____________________

- 1 –

1/14/2015

Yavapai County – Development Services Department

Checklist for dividing (splitting) Land

The following list outlines the necessary steps/items needed for processing a Minor Land Division

Permit

Note: The Minor Land Division process is not completed until it is recorded within six

months of Development Services approval.

DEVELOPMENT SERVICES:

Complete application in full and return to Development Services for review.

A processing fee as adopted by the Board of Supervisors.

Applicant must be owner on record and must sign (or the authorized representative sign) the forms

Legal Description of existing Parcel.

Legal Description(s) of proposed parcel(s) including access and utility easements.

Preliminary title report or other acceptable document that demonstrates legal access to the parcel(s).

A statement from an Arizona licensed surveyor or engineer, or other evidence acceptable to the

County, stating whether each lot, parcel or fractional interest has physical access that is traversable by

a two-wheel drive passenger motor vehicle.

A “to scale” map, titled “Results of Survey” or similar, with parcel areas and dimensions showing

existing and future parcel lines and all easements. The map/survey shall be sized 18” x 24” (at least

one 8.5” x 11” copy must be submitted) and of a format acceptable to the County Recorder’s Office.

The legal descriptions and the map/survey shall be prepared by an Arizona Registered Land Surveyor.

Map to illustrate any improvements (buildings, wells, waste water disposal systems) that may exist

and depict distances of all improvements from proposed property lines.

Notice of deficiencies if any.

- 2 -

Yavapai County – Development Services Department

NOTICE OF DEFICIENCIES

APN _________________

Access:

_________________________________________________________________________________

Zoning:

_________________________________________________________________________________

Undersigned applicant hereby certifies that he/she has read and understands the above

information and acknowledges receipt of any other relevant disclosures about the property as

prescribed by law. Applicant further states that any deficiencies noted above have been

investigated and applicant accepts same.

ACKNOWLEDGEMENT

No building permit, zoning clearance or use permit will be issued until the lot, parcel or fractional

interest has removed the above noted deficiencies.

Yavapai County assumes no liability with the required noticing of deficiencies

______________________________________________ Date __________________

Applicant’s Signature

- 3 -

Yavapai County – Development Services Department

STATEMENT OF ACCESS

The undersigned states as follows:

On ______________________, I inspected APN _____-____-_____, Lot # ___ ___ ___ ___ ___ and found the

properties were____ were not____ accessible by a two wheel drive vehicle.

______________________ ________________

Signature

- 4 -

Fill Online, Printable, Fillable, Blank MINOR LAND DIVISIONS PERMIT APPLICATION Form

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Fillable MINOR LAND DIVISIONS PERMIT APPLICATION

Fill Online, Printable, Fillable, Blank MINOR LAND DIVISIONS PERMIT APPLICATION Form

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