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May 04 10 04: 27p (763) 753-4665 p. 2 <br /> 04/28/2010 10:41 17158664206 W4GNER SURVEYING PAGE 02 <br /> ' Tees(must tctOntpaay fo.m): i <br /> �arnett.Ceunty Subdivision Permit Application rUW;VWoMWoS,1rVey: V0.00 <br /> and/or Pre-Application For1Dt Survey of Ez 1ie0l'+ 3 S OAOpar� <br /> �P/P s.roawh 9 is iog Pev: s:enno>sso.oa;oi <br /> I owner; SeRmi�R(> vy ! 7rE Buyer: _ y <br /> Addra�p Address: 3 <br /> Phata i.:, Phone: _ W <br /> QdEinal Parcel Information <br /> PaeeN`mK: O®IG•'ZH2�-07-1�� 2l 761( J <br /> / <br /> Section. _Towuship.��Range <br /> Oryi tat Deeerlpt on(or■tt■cti cowf <br /> py): 6• ✓a 7W 3 f <br /> I <br /> GSrrINt Zoata�: _I. t2� FloodplaiON, nw�et�landc'hl: <br /> arta ltrsr CI■ssitic■tion: T - Name of water Body: LLW h&4Y,- Lde K <br /> SAor"Agisemt or SIPS Y Farmland Preservation Y ]Keaaged Forestry Law Y <br /> New Parcel information` 71�� <br /> Proptiied3liewLege'l Description andParcel Size: <br /> pi r hu road _ <br /> Acres: _f466 <br /> (IfPi*M'b to be forveyed,provlde preliminary map. See attached for p-elimimiry map regvtremm( ) <br /> Prupbied■oda eo public road: .Uu!J h Q/YV'l Q pt i <br /> Prop(Y -$Cftn to public waten to be provided Y/O j <br /> If aaceat: <br /> eTStiefbwetr: 4�)�-�'•' �vr � _Date: <br /> C <br /> SrgttrrteifOwner• Date• o i <br /> >, Aaefpor¢af mail Zoning Rrgnnemen&? Yrr No <br /> n <br /> x <br /> I � > bloar pmeet reguiri¢Survey? fes No 0 <br /> D !)tdrQR" , p <br /> O ledfon v �� • J R2Cfrp � � <br /> i <br /> " O Rilaa¢eile■with Real Property Linter Yes No Dxre: .0 <br /> tfno��iTNii; OI <br /> J <br /> I <br /> (3 <br /> ApplkytNa• pproved / led Reason for Dental:_ <br /> Gva)Va yrs c•Nc-rdc-A,. A; �u <br /> LfM Date: /a <br />