*Contact Name:
*Company:
*Address:
*City:
*State: Choose a State Outside US / Canada Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Is Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Province du Quebec Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory *Zip:
*Phone:
Fax:
*Email:

Property Information:

Owner Name:
Business Name:
Property Address:
City: State:
Zip Code:

Required Completion Time: Please Select 10 days 15 days 21 days 30 days 45 days+

Instructions: Please include any special instructions or other information below.

Optional Items from TABLE A:
Please select the optional requirements from the list.

1. Monuments placed (or a reference monument or witness to the corner) at all major corners of the boundary of the property, unless already marked or referenced by an existing monument or witness to the corner.

2. Vicinity map showing the property surveyed in reference to nearby highway(s) or major street intersection(s).

3. Flood zone designation (with proper annotation based on Federal Flood Insurance Rate Maps or the state or local equivalent, by scaled map location and graphic plotting only.)

4. Land area as specified by the client.

5. Contours and the datum of the elevations.

6. Identify, and show if possible, setback, height, and floor space area restrictions of record or disclosed by applicable zoning or building codes (in addition to those recorded in subdivision maps). If none, so state.

7. (a) Exterior dimensions of all buildings at ground level.

7. (b) Square footage of: (1) exterior footprint of all buildings at ground level; (2) gross floor area of all buildings; or (3) other areas to be defined by the client.

7. (c) Measured height of all buildings above grade at a defined location. If no defined location is provided, the point of measurement shall be shown.

8. Substantial, visible improvements (in addition to buildings) such as signs, parking areas or structures, swimming pools, etc.

9. Parking areas and, if striped, the striping and the type (e.g. handicapped, motorcycle, regular, etc.) and number of parking spaces.

10. Indication of access to a public way such as curb cuts and driveways.

11. Location of utilities (representative examples of which are shown below) existing on or serving the surveyed property as determined by: (a) Observed evidence (b) Observed evidence together with plans and markings provided by client, utility companies, and other appropriate sources (with reference as to the source of information) including:

12. Governmental Agency survey-related requirements as specified by the client.

13. Names of adjoining owners of platted lands.

14. Observable evidence of earth moving work, building construction or building additions within recent months.

15. Any changes in street right of way lines either completed or proposed, and available from the controlling jurisdiction. Observable evidence of recent street or sidewalk construction or repairs.

16. Observable evidence of site use as a solid waste dump, sump or sanitary landfill.

17.