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'18/2007 14:05 6830633 FEDEX KINKCS PAGE� 034 <br /> /13/1994 11:16 17158F;k420b 11H1M-M tL"VLYIM <br /> FeeE(moat eccompatq'form): <br /> $ubdivislon wia Survey: F50.00 <br /> $UrflOtt COUllt�r SUba1V19101►Permit .&pPliCa C>1 survey of)listing parcel, $50.0011ot <br /> and/orPr''ee/-A}}pLplication F� orm sunatvi<;m wrsvtv�: $ <br /> zoo.00+Fso.00net <br /> �. I.. N� T r�yyh 6eU re►Ruyer. <br /> Owner: ,�•# 2V 24649 re�r,r�fr LNC <br /> Adtlrau: 90 l�l_}L��'� Adilress:., z <br /> liV•--r.•�ls�a.w e7Y " /r A .�077 .. <br /> Phone;ona: <br /> S(- IV • 7e1(2 Phone: <br /> — J <br /> Orieinai Parcel Information <br /> For:ItW�lDemsRriPtiOn <br /> d ^ Z/P w'-(LO a Section <br /> 2 Township �g Range <br /> — <br /> (or attach copy); L b 1 <br /> 2 r-r^ V-1 22 P 9zOfz <br /> t �{• Wctland&: t-ol�r <br /> Clrrrent zOninit: Floodpialop; <br /> A,alte!ltivar Glaeailication: <br /> 2 Name oRWater Body: Pe t.c Lk l <br /> New Parcel tnPorma " n c� <br /> f L exirfas r'p/.r � <br /> Proposed New Legal Description and Parcel Size: -- <br /> _ Acres. C f <br /> (If parcel Is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Propoaedd access to public road: &L:2:st p <br /> w <br /> Proposed access to ptiblic waters to be provldv&4-. ;"' P <br /> u atmcriba secetat ^ LAk f<o f <br /> w <br /> c <br /> Sipature of Owner; _ ate: <br /> a <br /> si�aature of Owner: Date: B <br /> 7 <br /> > Daos poroel meet Zoning Ragairemems? Yrs No <br /> a: <br /> pareai rtguF c a Sarvry? Yes No Q c. <br /> J <br /> a 5a s <br /> > i'ensk application f` submitted? ❑ Amount S a S(�• b Receipt$ <br /> a 13 Reconciles with Aenl Fraperty Lister Yes No Date: w <br /> ww <br /> ; x <br /> &Pistrexptain: '� � <br /> d C <br /> V <br /> ip <br /> AppllestfW; pproved Denied Reason for Denial• r l <br /> / ff <br /> Laaa 111eL Date; <br /> 0 <br />