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08/28/1994 20:30 17158664206 WAGNER SURVEYING PAGE 02 <br /> - •-� ••••v...I-, Aw„ A caiUAt hj/jJ1U%;XLlUII rcmtwucaccoffwyD=), <br /> and/or Pre-Application Form sa�'"d°R W*Svc $10.00 <br /> Subdivision w/Survey $25.00+S5.00Aot <br /> Owner. L0 At 4t;�7,+MV/ <br /> wddrem 131 S 4L4cbnvy� <br /> S�t. C,eo i x 4-//s /X),: bone:- <br /> nal ramel Inf rmadon <br /> Parcel ldeatt(katbn t : �N-/5�3-D/ <br /> Section a23 Township 37AI/ Range <br /> OrigivalDmdpdou(or attach co • z <br /> PY) <br /> r <br /> . . . S rto <br /> a <br /> W <br /> ,. Current <br /> s Zoabg: Floodplain YIN: Wetland s ; 1 <br /> n <br /> LakWRjm Cla mMi adon:• Name Of Water Body: <br /> ew breel Information <br /> P"W"Id'New Legal Descrtpdoe and par <br /> cceiSize: .r - =, <br /> y 4 <br /> nAcres: /g 2W ea <br /> (If pared b to be srgyeyed,protide prelirniaary map. See attached for prellmin■ry mp requiremeats.) <br /> proposed aceea to public road: wN . <br /> Proposed I to public waters to be provided Y& <br /> • <br /> D°srPertcelnmet7oninSBtgirinmentsT a No <br /> D sP l ragttlt+e a Su Wy? ya _ . .No <br /> Pennit°PPtJeerarrb„rittad? .ir►ronnts 3v;dv <br /> - Receipt <br /> RaeoneSee With Real Property ListerXes Mo Date: _ �o <br /> . ,.:. <br /> Application: 'moved' <br /> Dentedr, <br /> r Dev•i. l:Reason fo <br /> •' • �� -� � <br /> aad Use: <br /> d��` •.s.V.�^1' � � - .Dater 1,�... ,4:��.� .^�w .�[..�- Y <br /> Mll <br /> X2003 .t•'._ ,.�,,t,�._ •. <br /> iot,.�.t•;.a:ii��ii. ' k` <br />