(time stamp)
Official Use Only
Minor Preliminary Plat Application
A subdivision plat for not more than four lots within a tract of record.
The Minor Preliminary Plat will be reviewed and approved upon satisfactory
compliance with the Comprehensive Plan, Zoning Ordinance and pertinent Subdivision
Ordinance regulations.
Please complete the entire application and submit with the required documentation
and fee.
1. Applicant Information
Applicant (Print Name) Phone
Interest in Property (owner, renter, perspective buyer, etc.)
Address, City, State and Zip
Email
2. Developer Information
Developer (Print Name) Phone Email
Address, City, State and Zip
3. Property Owner Information
Property Owner (Print Name) Phone Email
Address, City, State and Zip
4. Subject Property Information
Property Address Zoning District
District and Parcel Number
Legal Description:
Project Description:
5. Filing Fee:
$264
+ $15 per lot (not
including outlots)
6. Attached Checklist
and Subdivision Plat Notes
2
Minor Preliminary Plat
No public streets are proposed
Not more than 4 lots within a tract of record (¼, ¼ Section)
No waivers requested
Submittal Requirements:
3 copies of the
Preliminary Plat + Electronic Copy
Application Form
Application Fee
-
$260.00 + $15 per lot, not including outlots
Process:
Intake
Submit completed application, Preliminary Plat and fee
Polk County contacts jurisdiction if within 2 miles
Review
10 working day review time by Polk County staff
E-mail comments to Applicant and Property Owner
Admin.
Approval
2 copies of the approved Preliminary Plat are stamped and retained by
Polk County
Approval e-mail is sent to Applicant and to Property Owner
3
Minor Preliminary Plat Checklist
Information Required
Map scale 1’=50’ or 1”=60’ or 1”=100’ if necessary
Plan size shall not exceed 24” X 36” *may be drawn on more than one sheet with appropriate match lines
Name of Development
Type of map or plat (preliminary, final, plat of survey)
Location of map or plat (address, city, township, section & range)
Legal Description of parcel and source of boundary information (plat book &page) and number acres
North arrow and scale
Owner’s and/or Developer’s name, address, telephone number
Surveyor’s name, address, telephone number
Registration and seal of surveyor
Date(s) prepared and revision dates
Location and names of adjoining subdivisions
Names of owners of all adjoining parcels
Identify adjacent parcels and their boundaries
Zoning classification
Boundaries of parcel to be subdivided in heavy line (phase lines, if multiple phases)
Front building setback lines
Vicinity sketch at a scale of 1 inch equals 2000 feet
Proposed lot lines, lot numbers, dimensions, and lot area (in square feet, if below 1 acre)
Existing and proposed topography (USGS datum) showing contour intervals of at least five (5) feet and at least two
contour elevations given in MSL
Location of natural, historical and archeological resources
Location, names and widths of all existing and proposed alleys, streets and highways adjacent or on the parcel or
adjoining parcels including pavement widths
Existing land uses including structures and setbacks
Existing railroads, above and underground utilities and utility poles
Location and areas of drainageways, streams, lakes and ponds, marshes, swamps and wetlands, and proposed
storm sewers
Location, area and elevations of floodway and flood fringe from Flood Hazard Boundary Maps
Location of masses of trees, and isolated trees with diameter greater than 16 inches
Location, dimension and size of permanent runoff control structures
Source of water, source of sewage disposal and location of proposed service pipes
Location, width and type of easements for public utilities: sanitary sewer, water, storm sewer, gas, electric, cable
TV
Location, dimensions and size of common areas and open space areas under Owner Association control
Location, dimensions and size of areas proposed for public dedication and use
4
Please add the following notes as applicable:
Mailboxes within the road right-of-way shall be of a breakaway design.
The existing buildings noted to be removed shall be done so prior to final plat approval.
Access to [insert state highway name here] must be approved by the Iowa Department of Transportation.
Any subsurface drainage facilities that are disturbed must be restored or rerouted by the property owner.
Services to all utilities located on the opposite side of the roadway must be bored under the roadway at
the lot owner's expense.
Maintenance of all drainage easements to be the responsibility of the property owner.
Culverts to be used for crossing drainage easements must be designed by a licensed professional
engineer.
Post development runoff will not adversely affect downstream drainage facilities or property owners.
Due to soil types, limitations, and disturbance, alternative septic systems may be required. Individual
wastewater treatment systems shall be designed by an Engineer.
Any access restriction may be revised or removed by the Polk County Public Works Department.
Note utility service providers.
Polk County Public Works, Planning & Development Division
5885 NE 14
th
Street, Des Moines, IA 50313
▪ Phone (515) 286-3705 Forms available online
http://www.polkcountyiowa.gov/PublicWorks/