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:Fees(must accompany form):llrnett County Subdivision Permit Application ivision w/o Survey: $10.00and/or Pre-Application Form ivision w/Survey: $25.00+$5.00/lot <br /> v1/vd �oV-d /Y1Qil /Zas�l �! � <br /> Owner: �� a /S <br /> Address: <br /> �i/ <br /> Phone: _L5— ll g ' 02 9 0 /37 <br /> A <br /> Ori incl Parcel Information 3 <br /> FParcelentification#: 64a-��� -��°ORection 02 / Township 3�Rangez <br /> Description (or attach copy):: aj <br /> If <br /> �i{/I Z, Floodplain Y/N: Wetlands Y/N: A <br /> � Current Zoning: P <br /> , <br /> y <br /> ° La /Rive Classification: Name of Water Body: <br /> n Iv <br /> m <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 6AZ2p l f' N w Y/ <br /> °� <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> i tcun 2d 74 <br /> d <br /> Proposed access to public waters to be provided Y/N: �d <br /> If yes,describe access: /V/A <br /> — W <br /> ➢ Does parcel meet Zoning Requirements?' Yes No <br /> 6. <br /> Nf1 <br /> °o ➢ Does parcel require a Survey? Yes No 3 <br /> ➢ Permit application fees submitted? Amount$ Receipt#_ P <br /> r <br /> ❑ Reconciles With Real Property Lister Ye No Date: 23 V <br /> a L) <br /> If not,explain: <br /> 0 <br /> a. <br /> H <br /> ApplicatApprove / Denied Reason for Denial: Q j <br /> Land Use: <br /> Date: <br /> 2/18/2003 <br />