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:- . S a ,x'.. ,,,-. , ;ya' awaz ' d ,s <br /> e a` Div`.■��+y��Y # County {' tt m <br /> "^ division Pertuit Ai'plitrattou 1 wTl'+1h11L1,TE=I YH JSEc rJ�?0.00 <br /> and/or Pr lira s, e <br /> ��� y- Exiscw$Yar�t:$so.oa;k�c <br /> � '. w Stiabdi,,tica w%Survrv- S20o.p0 4-S50.00llrst i <br /> qn Patrick& iciti O'Brien ``�klCael" ;fir <br /> Address: <br /> i tfrais Rd G <br /> Address: <br /> z .1. <br /> Esntan phi 55603 2 <br /> x <br /> 3r": Phone:one: <br /> i. 6121-369-6170 - _ W <br /> Phone: <br /> O54- Parq I Information W <br /> 07 032-2�11 17 35-5 15-054-01013QQ0 <br /> t'xrcet 11)4#: 07-032-2-41-17-36-5 15-054-0140 Section :64 <br /> 41N 17Y1!t?QTownship Range 2Gri;lnal De7scription(or attach copy}: Biock Bear Acres l ots <br /> ri <br /> 1 , �--- <br /> t <br /> (.¢srrentZonirsg: Fi3 'kod twinN N <br /> �~ <br /> a p Y/N.� I,etland. Yr=ti. l.ak River Class: t. <br /> �( <br /> `' Name Cif tT titer Boris': N/A <br /> Shotctsnd.i Agreement/SIPS '1",s <br /> r -- <br /> *Pr <br /> P 'FarmlandPreservation1r'"lei: Managed ForestryLaw Yl : ri <br /> New Parcel Information -,; <br /> 7 <br /> d t pi,,,Dose�t7 New Legal Description and taarcel Size; CSM combit}e tots <br /> 1 <br /> Acres. 10.0 <br /> + � — <br /> Y tllf'ix�arcei iv to tic Saar ed,prc+ride prelinilrarti anap. See attached for pretisr+inarrt map requirements.) <br /> t� <br /> ~ I'ropt-ed access to pnhh-a aact. ;; <br /> I a <br /> Proposed access to paixtic waters .crs to provided•1"N; <br /> If yes,describe access: <br /> s ° <br /> r / <br /> i o owner:` i! Bate; J � e!. <br /> L'nej arce;meet Zc.V ongRequirements. Yes , `v <br /> s' , Does parcel roquir,:.a.'Sarr,eye:' Yes 4clt <br /> r^ Permit application fetes subraiits ? Amount Ffr <br /> i{ece�z �% <br /> r C7& esonciles with Real Property r ester 'ev Aa I➢at+: —_ <br /> ----- W, <br /> r"" If noG ealstaita , <br /> ,_._____ • tJ <br /> o — <br /> tspiksticr€a: laproved , I}e, ta+� � for , �` 1 V 1 <br /> Use: 4# x� t' #sa : "_^ - <br />