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Request to Reserve Subdivision Name

Clackamas County Surveyor
150 Beavercreek Road
Oregon City, OR 97045
(503) 742-4475 / FAX (503) 742-4481
E-mail address: surveyor@co.clackamas.or.us

Plat Name Requested:

Location of Plat:
TWP/RANGE:
SECTION#:
QTR SECTION:
TAX LOT#(s):

Planning Jurisdiction:

I understand that if the above name plat is not pending or recorded within two years, the name will be removed from the reserved list.
Requested by:

Date:
Telephone:
Fax:
Email:

Plat Surveyor:

Name of Developer:

Address:

Telephone:
Fax:
Email: