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SITE PLAN FOR PROPOSED RESIDENTIAL DEVELOPMENT <br /> Site Address: <br /> Township Range Section Tax Lot Total Acres <br /> Subdivision Block Lot <br /> D Drawn to Scale: •® Not Drawn to Scale -OR- 1 square= feet <br /> I certify that the above information is accurate to the best of my knowledge.I AM THE[ ]Owner or[ ]Authorized Agent. <br /> NAME(please print): Telephone# <br /> Applicant's Signature: Date: <br /> Applicant's Mailing Address: <br /> City: Zip: Applicant's email: <br /> S-31-1-2017 <br />