ACC Request Form

Property Improvement Request Form

Tobin Creek Home Owners Association P.O. Box 580391 Pleasant Prairie, WI 53158
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2
Email *
Type of Improvement or Change
The Architectural Control Committee is allowed up to 30 days from the date of the receipt of completed form and all relevant materials to approve or reject the request.
Type of Improvement
Type of Improvement (other)
Description *
Please describe in greater detail
Materials *
Please describe the types of material used or changes in color
Start Date *

Month Day Year
End Date *

Month Day Year
Completed work must be reviewed by the ACC and it is the responsibility of the homeowner to contact the ACC following completion.
Implementer *

Home Owner Contractor
Contractor Name
Contractor Phone Number

Area Code Phone Number
Contractor Email
example@example.com
Have you obtained required permits from the Village of Pleasant Prairie: *

N/A Yes No
Permit Information, if applicable
Please include and attach the following information (if applicable):
- Plot plan indicating the location dimensions of the project.
- Blueprints or working drawings indicating all necessary dimensions and elevations. You may choose to submit a copy of the advertisement that shows the completed project, as well as the dimensions and material for construction.
- A photograph, drawing, image or other visual material.
- Plans, specifications or bids from contractors.
File Upload
*All submitted materials shall remain the property of the ACC and the Association.
I hereby acknowledge that I have read and fully understand the Tobin Creek Restrictive Covenants including Section III. I also assure the ACC and all Tobin Creek Homeowners that all improvements will be installed in a professional, workmanlike manner, and will be properly maintained.
Signature *

Clear
*** BELOW - ACC ADMINISTRATIVE USE ONLY**
Status

Reviewed Approved Rejected
Reviewed On

Month Day Year
Reviewer Signature
Approved on

Month Day Year
Date
Approver Signature
Conditions for Approval
Reasons for Rejection
If you wish to appeal the ACC decision regarding the decision below, please appeal to the ACC within 30 days. Plans not completed within one year from the date of approval (unless otherwise noted below) are no longer valid and a new ACC Request Form must be submitted for review.
Should be Empty:

Type of Improvement or Change

Please include and attach the following information (if applicable):