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nrnett County SU IYISfon Yermit Application S5000 <br /> 26 /ILF�!/t S�/Uv2 <br /> Surveyor Evmmspovd: S50.00/la <br /> ?79 and/or Pre-Application Form Subdisision wl Su ev: 5200.00+g50.OG90t <br /> lUcl z/ X1 <br /> o14FrB,/ t /J <� -.5* / — <br /> � �euer>z �O s s� B»>�>': dcL-f'�CL <br /> Address: �79�y AO"d-C/t Address: � 7//O / /�G'�Q� /Vr�/✓.� <br /> Phone: / l✓- D(O(/�- 5 3l Phone: <br /> 6z- �_ <br /> � 4 <br /> ricins arcel nformation <br /> 69.0lZ-Z' Yo-/5-z5-/ �Z- pvD, O/icc`o rt�s// E/ . / <br /> ParcellDd: 67-e, 2 'Z-YO-/5-15-/ Z'��" `Seco Township '/W RanV /�s'✓ <br /> o 9-012- 2- Tf6 <br /> Ori- <br /> trial Description(or attach copy): <br /> /V <br /> Current Zoning: Floodplain 16 _ Rethit-A Y6--- <br /> LakdRtver Classification Name of Rater Body: <br /> `� J <br /> Shoreland Agreemt or SIPS Y Farmland Preservation V_Managed Forestry Law1 <br /> New Parcel Information � fG <br /> Proposed New Legal Description and Parcel Size: ._�J�Y7 �J�(' J _ <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached <br /> for <br /> preliminary map requirements.) <br /> Proposed access to public road: _� �.� Q. c/z✓�`--� O <br /> c <br /> Proposed access to public waters to be provided Y n <br /> If ves,describe access: <br /> Z <br /> Signature of Owner:f J-AaVYy.Q i h/J177�CJv`/ Date: <br /> Signature of Owner. �f - Date: <br /> 3 <br /> ➢ Does parcel meet Zor ' g Regm vs? Yes No _ <br /> N <br /> o u <br /> ➢ <br /> Does parcel require a Survey? Yes No <br /> w' <br /> Y Permit[application fees subrnirted? ❑ Miouru $ LIIA= Receipt N <br /> r' ❑ Reconciles with Real Property Lister Yes No Date: <br /> c <br /> i <br /> F If not,explain:___ __ I <br /> APPlicatto . Approved ! _ <br /> ted Reason for Denial: __— — - J <br /> Land Use: Date: 9 81, <br />