New Page 2

Carter County Planning

PO Box 315***214 Park Street

Ekalaka, Montana 59324

Phone (406) 775-8749 Fax (406) 775-8750 Email: cccnrc@midrivers.com

Pre-Application Questionnaire

Note to landowners: Please refer to Montana's Subdivision and Surveying Laws and Regulations in making application for a subdivision.

Major Subdivision Minor Subdivision Boundary Change Family Transfer Other

Date ____________ Project Name ____________________________________________________________

Land Owner:________________________________________________

Mailing Address:_____________________________________________________________________________________________

City/Sate/ Zip:_______________________________________________ Phone:_________________________________________

Email Address:______________________________________________________________________________________________

Brief description of survey purpose:__________________________________________________________________________

Surveyor Name: ___________________________________Company: _______________________________________________

Mailing Address: ___________________________________City/State/Zip:___________________________________________

Phone: _______________________________E-mail address:_______________________________________________________

Applicant Signature: _______________________________________________________________Date: ____________________

Property Information

Legal Description ( Attach Tax Notice record):________________________________________________________________

Physical Address of Parcel:__________________________________________________________________________________

Development Characteristics (proposed number of lots, existing water and sewer systems, existing structures, easements):_________________________________________________________________________________________________

LAND USE & DOCUMENTATION INFORMATION

1. information on the current land use status of the site to include the following -

a. Past and current land use and any existing structure(s):

b. Current use of surrounding property

c. Description of general terrain

d. Location of existing conservation easements

e. Are there existing covenants of deed restrictions? (if so, describe or attach)

f. Location of any noxious weeds:

2. Documentation of the current status of the site, including:

a. Ownership information, such as a deed, option to buy of buy-sell agreement, including permission to subdivide (please attach):

b. Water rights, including location of Agricultural Water User Facilities

c. Mineral rights

d. Are there any Special Improvement Districts? If so list attach.

e. Are there any Rights of First refusal for the property?

f. Lien Holder's acknowledgement of subdivision: (if applicable, please attach)

ADDITIONAL REMARKS:

____________________________________________________________________________________________________________

Office Use Only

Applicable Fees Paid for Review: Date_______________ Check#__________________