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IHlriiiii uountyDUbfLYlslon Permit Application �Subdivision wto Survey $50.00 <br /> /f and/or Pre A lica Sg of Existing Parcel: $50.00tiot <br /> ` O ita le- pp tioud %rMWTER/SCAIly sion wt Survw: szd0MIS50.001let <br /> _ R. Macl eo j <br /> Owner: A/fyL�h rr(s Off�t Buyer: R(a£ fflfir� ) IYI 'pt Q, y <br /> Address: �( <br /> _3n]2 ilntl ni' Q_� G1 Address: N2q6Th S—� '3 <br /> 1�ebsrP_r, hls .54v9� l3�doe�flc�C, �� 5<I'l�3 <br /> Phone: J�,J�-S(l�It-`/ L� Phone: <br /> Original Parcel Information O <br /> Parce]ID7l: p(/ 5 V S'CP<j-Section 24) Townsbipi�/L�Rnnge/±ItV �O <br /> n2. 0 <br /> Original Description <br /> (or attach copy): (-VL FAV lrT9 (L trr, Fsla lr 7n Le/RtL.�SIiNn cal , <br /> a / � <br /> e <br /> � S <br /> ^m <br /> Current Zoning: R:� Floodplain YM: ft'(i Wetlan77ds Yl/Pii A/ <br /> LakefRiver Classification: Name of Water Body:_� K 'L R re f . _ <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: <br /> (if parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) O <br /> Proposed access to public road: Fn <br /> o O <br /> Proposed access to public waren lobe provided YM: N/ 91 <br /> If yes,describe access: <br /> 31 � <br /> o Signature of Owner. Q, Date: 613 U.1 <br /> � 1 <br /> C1 ��� �� � - �6 aot3 g <br /> p° Signature of Owner: F7Ukt G l.F.r—� Date: <br /> 9 <br /> > Dou parcel meet Zaning Requfremerttr? / Yes No ° t <br /> > Does parcel require a Survey? yesNo g <br /> > Permit applicationfees submitted? Amount$ JV.VV Receipt <br /> 6 <br /> O Reconciles with Real Property ListerYes No Date: 4114lN� o C <br /> If not,explain: - <br /> VJ <br /> Applicatiended Reason for Denial: - <br /> / —) <br /> 1U Land Use: /�/ //�� Date:_ <br />