Form Center

2. Development Name*
3. Plat Title
5. Development Location*
7. City*
8. State*
9. Zip Code*
13. Petitioner Name *

    (Must Be Property Owner)

14. Authorized Party*
16. The Petitioner is a:*
    -- Select One --LLCLPPartnershipSole ProprietorshipCorporationLandowner (For Single Family Home)
18. The Authorized Party is the:*
    -- Select One --MemberManaging MemberManager
20. The Authorized Party is the:*
    -- Select One --General PartnerPartner
22. The Authorized Party is the:*
    -- Select One --Partner
24. The Authorized Party is the:*
    -- Select One --OwnerOwners
26. The Authorized Party is the:*
    -- Select One --PresidentVice President
28. The Authorized Party is the:*
    -- Select One --Owner(s)
30. Contact Person (If Different)
32. Phone Number*
33. Email Address*
35. Address*
37. City*
38. State*
39. Zip Code*
43. Engineering Firm*
44. Contact Person*
46. Address*
48. City*
49. State*
50. Zip Code*
52. Phone Number*
53. Email Address*
57. Additional Petitioners
59. Would you like to add a second petitioner?*

    1. Yes
    2. No
61. 2nd Petitioner Name*
62. Authorized Party*
64. The Petitioner is a:*
    -- Select One --LLCLPPartnershipSole ProprietorshipCorporationLandowner (For Single Family Home)
66. The Authorized Party is the:*
68. Contact Person (If Different)
70. Address*
72. City*
73. State*
74. Zip Code*
76. Phone Number*
77. Email Address*
79. Would you like to add a third petitioner?*

    1. Yes
    2. No
81. 3rd Petitioner Name*
82. Authorized Party*
84. The Petitioner is a:*
    -- Select One --LLCLPPartnershipSole ProprietorshipCorporationLandowner (For Single Family Home)
86. The Authorized Party is the:*
88. Contact Person (If Different)
90. Address*
92. City*
93. State*
94. Zip Code*
96. Phone Number*
97. Email Address*
101. Minimum Fireflow Requirements*

     List the minimum fire flow requirements in GPM

105. Plan Attachments

     Please upload .dwg or .pdf files only. File names must not include special characters. [example - +,$, %, &, *]

107. Upload pdf of Civil plans here:*
108. Upload pdf of Sanitary plans here:*
110. Upload pdf of plat here:*
111. Upload CAD basemap here:*
113. Upload CAD plat here:*
115. Do you have landscape plans that aren't part of the street plan set? *

     1. Yes
     2. No
117. Upload Landscape Plans here*
119. Attach any additional documents here (optional)
123. I attest that the plans submitted have addressed at least one round of City and Johnson County Wastewater (JCW) comments.*

     1. Agree
125. Your Name*
126. Your Email*
Leave This Blank:


128. 1. Receive an email copy of this form.
129. Email address

     This field is not part of the form submission.

130. Submit

* indicates a required field