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Fees(must accompany form): <br /> iDu.urnIlett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> Surve of Existing Parcel: $50.00/lot <br /> and/or Pre-Application Form � Antj <br /> U 1/ At fro Owner; uyer: d <br /> Address: 2 k Address /" OZ-oa0— <br /> z <br /> o. <br /> Phone: 1 - Z c-3 9- 3 I I D PI, <br /> rT U /�U��- �l�l/" L ✓ ®1'lalnll Parcel ](n09'n1at10Information �/ , / <br /> Parcel ID#: OI�G'o�'-o�lODCS Section �36 Township /lN Range /�w <br /> Original Description (or attach copy): �� _5_P ) A/W 5E , '5C �d <br /> tCkze, I-o 7�s l - 3 7 <br /> Current Zonin2: � / r /` � Floodplai&N: Wetland Y/ : <br /> Lake/River Classification: Name of Water Body: (i1[ V 6hL <br /> Shoreland Agreemt or SIPS Y Farmland Preservation X/ 1�: 1vTanaged Forestry Law /N• �� <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: AS, y <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: L�-�1e�llAlJ Alp-, C� b 7 C&& <br /> Proposed access to public waters to be provided YIN: <br /> L�, e z led <br /> If yes,describe access: <br /> v <br /> gnature of Owner: Dater <br /> 0 <br /> uc Signature of Owner: Date: c <br /> a <br /> 9 Does parcel meet Zoning Requirements? Yes No <br /> r A Does parcel require a Survey? Yes No <br /> c. <br /> 9 Permit application fees submitted? ❑ Amount Receipt# <br /> n <br /> 0 <br /> c <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: - - r -a <br /> i <br /> Application: Approved / Denied Reason for Denial: <br /> Br ._ JNTY <br /> Land Use: Date: <br />