CITY OF ESPAŇOLA
Application#:
Receipt #:
Daily Report:
Amount Paid:
Rec’d By:
Planning & Land Use Department
405 N. Paseo de Oñate, Española, NM 87532
SURVEY PLAT REVIEW
Property Owner:
Physical Address:
Phone Number:
I.
a.
b.
c.
Surveyor:
Address:
Phone Number:
PL AT I NFO RM A TI O N
Boundary Survey
Alternate Summary
Subdivision; #of Lots
Lot Split
SURVEYOR
CERTIFICATION:
PARCEL
INFORMATION:
II .
TYPE OF REVIEW:
UPC#:
Lot#:
Block#
Tract#:
Township:
Range:
Section:
d.
COUNTY:
e.
SURVEY PLAT
INFORMATION:
MU N IC I P AL I NF OR M A TIO N
PLANNING
COMMISSION REVIEW:
i.
ii.
Date of Approval:
ZONING DISTRICT:
iii.
PHYSICAL ADDRESS:
iv.
LAND USE:
Site Built Home
Commercial
Industrial
Rio Arriba
Santa Fe
v.
NUMBER OF STRUCTURES:
# Principle Structures:
# Accessory Structures:
Vicinity Map
Plat Scale:
ft.
f.
BENCHMARK-ELEVATION POINT:
ENCROACHMENTS:
h.
EASEMENTS:
Water
Wastewater
Natural Gas
Electrical
ROW
Acequia
Drainage
Ingress/Egress
i.
TOTAL AREA:
Tract 1:
Tract 2:
Tract 3:
Tract 4:
Direction
ft.
FrontRearClosest Structure-
Side1Side 2-
vi.
SETBACKS:
vii.
LOT COVERAGE:
viii.
ix.
x.
xi.
FLOOD PLAIN:
COMMUNITY NUMBER:
PANEL:
MUNICIPAL UTILITIES AVAILABLE:
Distance to Water LineDistance to Wastewater LineNEAREST PUBLIC ROW:
Survey Title:
g.
Single Wide Mobile Home
Double Wide Mobile Home
Triple Wide Mobile Home
(Check all that are included)
North Arrow
Yes
No
Width
xii.
Yes
No
I hereby certify that the information and survey presented for review is true and
correct to the best of my knowledge. I acknowledge that by completing the
application, I am acting with the knowledge and consent of the property owner(s).
This review may be delayed, should the information provided be incomplete,
inaccurate or require special reviews and/or approvals.
Applicant Signature
Date
Staff Signature
Date
APPROVED
DENIED
FEE: $