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ifiirrieiii:ounty :iuniiivision rermft application I Sabdfdsfoawusurvey. S50-00 <br /> Survey of Existing Pmeel: f30.00Ao1 <br /> and/or Pre-ApPTiMdMUpEpSCANNED Samivi inaw/sarvev: s200.00.s50.omat <br /> Cnitflt C I . (YlAC LeD <br /> Owner: /(�7/.L •�r fi r r - t ✓e l^ Buyer: h r Y N r ti^P V r S <br /> nn n <br /> Address: N 1 .3</ N-� 9l'Lti S'/' Address: .1 `f 79 P'6i, SmT, <br /> I"5ir�..r 1f11 ANri' /J _ -1 . F6 $ It'd` It�T_"ri l� at% ° <br /> Phone: _7/.5 '-LI.S S-' I F �„j Phone: <br /> Ori¢inel Parcel Information <br /> Parcel lD#: (1q- )2N -2 -.7P- 5i�7—Section tel)TowwhipRange [/ O <br /> L17�D0 F <br /> Original Description(or attach copy): <br /> n <br /> a <br /> e <br /> Current Zoning: Floodplain Y/N: Nn Wetlands Y/N: <br /> Lake/River Classification: Name of Water Body: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: <br /> (If parcel is to he surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: h(' <br /> 0 <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> SU <br /> Q/J � / <br /> N Signature of Owner: '-�--L� F �-', Dmc• <br /> a � <br /> °O Signature of Owner: � _ ^(�'� Date: u s 3 <br /> 9 p <br /> > Does parcel meet Zaning Requfremertr . Yes � No ° 11 Inn <br /> � VI <br /> > Does parcel require a Survey? 'YWI No <br /> > permit applicationfeessubmWede Amourtt$ 50,X R.ipt# �? <br /> , <br /> a s �1 <br /> 6 <br /> q,Recoociles with Real Property Lister CYes No Date: 1*2j.�01)4n SJ O <br /> O <br /> If not,explain: I O 6 <br /> _ d <br /> Applicationproved / Deniied Reason for Denial• �1 O <br /> Land Use: Date: Z7-p3 - (� <br /> /41�-av/3 <br />