Property Owner’s Name ...................................................................... Tel. No. ...........................

Property Tax No. ............................................ Existing Land Use ..................................................

Community Name ......................................... Date of Purchase (or inheritance) ..........................

Property Frontage (public or private road) ....................Road Name ................................................

2 . Subdivision Information:(please check)

( ) revision to existing lot ( ) consolidation of lot(s) ( ) subdividing of lot(s) and / or a parcel of land If subdividing, please denote number of lots and use .........................................

3 . Type of Servicing: (please check )

( ) individual well(s) and individual sewage disposal system(s)

( ) central water & central sewage disposal system

( ) other, please describe .................................................................................................................

4 . Correspondence should be addressed to:

Applicant’s Name ................................................................................ Postal Code ......................

Mailing Address ...............................................................................................................................

Telephone (H) ................... (W) .................... Fax ................... E-mail ..........................................

..................................................................................... Owner's Signature

................................................ Date

Please Note

This application must be accompanied by :

For five or fewer lots:

1) a copy of a property map (geo-linc map) showing the true shape and dimensions of the property being subdivided, the proposed lots, and all roads or rights-of ways proposed for access to the lots.

More than five lots:

2) a copy of the property map along with four (4) copies of a preliminary plan prepared in accordance with the requirements as outlined in the bylaws, and

3) An application fee - $150 per lot (Cheque payable to: Eastern Kings Community Council)

The application along with the application fee should be forwarded to the above address. For further information and / or assistance, please drop into the community office (Eastern Kings Fire Hall (Tuesday morning) or phone the community office.

Municipality Use Only:

Date Application Received: ...................................................... Fees Received: ............................