Laserfiche WebLink
02/24/2009 11:44 5076652191 MN VALLEY HLTH CNT4 PAGE 01 <br /> wAghtr: SIkVEt IM3 PAGE. f2 <br /> Hu►nerf'n �� • orm F IM <br /> I'm <br /> er nw A. �. .•..•—._.__.� <br /> M nwiy Cwh4:..;.i.w L�.,...ie a1y�lt�ael4n �Mnuonwrvey, �33U,Op <br /> and/or Pre-A Lcation FS eeyotExietfappaltel: tsao U <br /> Sv divlaien w.fur•ev: 5100.p0 a SSO.J_Nhc_ <br /> R2K tyiNtfaLTz - <br /> ,)weer. �= �im �.E•G. E� r-� <br /> - �——�— <br /> Addnae J70 AR4? 57-#V/- Address: /moi-90y G 55 Ti�'4 <br /> Phone: _ <br /> Original Plxeetlnformat on M / ?�/ <br /> pareelto0062 yi//-pyG/I 111*0.7y-`w. 0y4k <br /> 9/ <br /> iion�—_,Tdwnphlp yL l�Auigs /�n/ d <br /> orwisal Description(or attach COPY), La 7—./ C'f /)! V/G P& <br /> n <br /> �,,, Hlcoaptatn�Y N: — wens ds Yj <br /> [+hi�eer ChaalMatloa, )--. Name or water Sody: <br /> J& C <br /> �Ili/aititsd Asraemt or SMS Y1N.—rarmisad Prest"sttow V6)—Han, Fo.ratry LAW YQ <br /> MM <br /> 1 arcal Information s <br /> FPr "d" New 14101 Description and Parrot eem? � <br /> Acres: <br /> [rep.....a�-�-�•-�••-,..+:r.....s y.c.u.....ery a.eEL Vee atlacntd 1(Y paelimina map rtqulreantnta.) <br /> nelreNe agasae co Dubuc road: f}OLS tilt LAKE <br /> pt opoN1$00"to public waters to be provided YC:% <br /> 911�IM7f 0lOwnen _ _.—bs e: __ O O <br /> ��� 11pYllrrofOwnerl 12_-. _ Al bs e: 212 <br /> > <br /> Dow Pam[meet Zon/nlRequirememm? Yea NO ':, 'I <br /> a <br /> r > 71NY parerlrequJ,e a Survey? No <br /> 6Uv <br /> 2 Y ❑ Amuunt S_ Receipt k <br /> d=ellft with tial Property Lister Yes NO <br /> AppMtb rf Appro.ed / enlM Aettton for Den,nt: _—,.�-y-- <br />