Survey Review Checklist

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MUSSELSHELL COUNTY
Survey Review Checklist

Date:
File No.
Submitting Land Surveyor:

EXEMPTION CLAIMED: ☐Boundary Relocation ☐Family Transfer ☐Mortgage ☐Court Ordered
☐Retracement ☐Ag Tract ☐Misc. (public utility site, cemetery, etc.)

PLANNING/ZONING APPROVAL:
☐Provide documentation of survey approval by City (Applicable ONLY for survey lying within city limits of Roundup or Melstone)

SANITARIAN APPROVAL:
Provide Documentation of approval by County Sanitarian

INITIAL REVIEW
☐Name(s) of Owners
☐Title Block
☐Names of adjoiners and/or adjoining Cert. of Survey
☐Legal Description of tract surveyed, and any remainders less than 20 acres
☐Dimensions and area of each parcel proposed
☐All parcels (existing and proposed) labeled by number or letter
☐Certificate of County Treasurer
☐Landowner certificate citing subdivision exemption (N/A for retracement)
☐Certificate of Examining Land Surveyor
☐Sanitaryrestrictionexemptionordocumentationofreviewapproval
☐Date Survey Completed (must be within 180 days of filing)
☐SignatureandSealofLicensedProfessionalLandSurveyor
☐Deed for tract(s) surveyed
☐(BoundaryRelocationOnly)Signaturesofalllandownerswhoseparcelswillbealteredbythesurvey
☐(BoundaryRelocationOnly)Boundaryofresultingparcel,ifaboundaryiscompletelyeliminated
☐(BoundaryRelocationOnly)Lotsmodifiedinaplattedsubdivisionmustbeentitled“AmendedPlatofthe 
(subdivision)”, but for all other purposes if a Certificate of Survey
☐(FamilyTransferOnly)NameofGrantee,RelationshipofGrantee/Grantor,ParceltobeconveyedtoGrantee
☐(Ag-TractExemptionOnly)Covenantlanguageonsurvey

Initial Review Completed by:
Date:

FINAL REVIEW
☐Corrections/Revisions completed as requested
☐Notarized signature of landowner(s)
☐Signed Stamp and Date by Licensed Professional Land Surveyor
☐Deed for newly created parcel(s)
☐(Boundary Relocation Only) Quit claim or warranty deed or recordable agreement from adjoining landowner for 
that portion of the tract(s) being altered
☐(Mortgage Survey Only) Letter from lending institution that requested survey
☐(Court-Ordered Survey Only) Copy of judicial document that ordered survey

Final Review completed by:
Date: