NOTE: All statements must be submitted in both
paper and electronic format.
|
Type of Subdivision or Land Development
|
Type of Impact Statement
| |||
---|---|---|---|---|
Developer Financial Disclosure Statement
|
Educational Impact Study
|
Transportation Impact Study
|
Impact Assessment*
| |
Residential subdivision of less than 10 dwellings or parcels
| ||||
Residential subdivision of 10 or more
|
Required
|
Required
|
Required
|
Required
|
Land development
|
Required
|
Required
|
Required
|
Required
|
Nonresidential subdivision
|
Required
|
Required
|
Required
|
Required
|
Zoning change
|
Required
| |||
Conditional use
|
Required
| |||
Special exception
|
Required
|
NOTES:
*Includes scope, compatibility, location, photographs, description
of project, physical resources inventory, biological resources inventory,
land use inventory, surface water inventory, subsurface water inventory,
existing features inventory, historic features inventory, visual resources
inventory, community needs inventory, utility needs inventory, transportation
system inventory, fiscal impact, existing conditions, licenses and
permits, and design analysis.
|
Developer Name:
| |||
e-mail:
| |||
Owner:
| |||
e-mail:
| |||
Statement of disclosures
| |||
Name of subdivision:
| |||
Location:
| |||
Name of developer:
| |||
Developer's address:
| |||
Authorized agent:
| |||
Authorized agent's address:
| |||
Developers and holders of ownership interests in violations,
bankruptcies and litigation.
| |||
(a)
|
Holder of ownership interest:
| ||
Type of legal entity:
| |||
List of corporate officers and business associations of each
officer:
| |||
Extent and type of interest:
| |||
(b)
|
Holder of interest in land:
| ||
Type of legal entity:
| |||
List of corporate officers:
| |||
List of corporate officers and business associations of each
officer:
| |||
Extent and type of interest:
| |||
(c)
|
Violations, bankruptcies and litigation:
| ||
[1]
|
| ||
[2]
|
| ||
[3]
|
| ||
(d)
|
Supporting documentation:
| ||
[1]
|
| ||
[2]
|
| ||
Affirmation
| |||
I hereby affirm that I am the senior executive officer of the
developer of the lots herein described or will be the senior executive
officer of the developer at the time lots are offered for sale or
lease to the public or that I am the agent authorized by the senior
executive officer of such developer to complete this statement (if
agent, submit written authorization to act as agent);
| |||
That the statements contained in this disclosure statement,
together with any documents submitted herewith, are full, true, complete
and correct;
| |||
That the developer is bound to carry out the promise and obligations
set forth in this disclosure statement or that I have clearly delineated
the proposals for which the developer is not bound and stated who
is or will be responsible, if anyone.
| |||
|
| ||
(Date)
|
(Signature)
| ||
|
| ||
(Corporate Seal if applicable)
|
(Title)
|