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II melt ( omoli <br /> it Sdi%i%ion Permit Application <br /> Subds,1%11,11 woo Olney $30 00 <br /> and or l're- kpplication Form or \lap Re‘ievw Form <br /> stews,at t cosi%hind ISO Oesi r <br /> ...01xli*waft sit Slimy 5200 00•Ss ,, • <br /> Emanuel Gavano <br /> 0,aer; deer: — <br /> r PrMONT AVE S <br /> Afidrir s Aildris : _.„....,_ _ <br /> A'S MN 55409 <br /> 612 730-' lb: <br /> Phone: t <br /> ______, <br /> 'st <br /> it <br /> Original Parcel Infurrnaticia <br /> _Ran, 14 to, ii, <br /> Parrrf II)is: 03P510302210 Section Tows hip 41 <br /> I; <br /> ' f <br /> Original DeW'st 900oGov Lot 3 <br /> scription tar attach cop : <br /> RR-1 <br /> Current 7.00ing: Illoodplala Vat: f'.4 IA cdands ViN: N Lake/Riser Class: NIA 'N <br /> !Name of Water Body: Adams Lake Shoreland gretmentiSIPS I"N: ? <br /> ' \Farmland Prnervadoa YLNI: N Managed Forestry law It'so: - <br /> Lviert fanclInformation <br /> The new CSM will divrde and create 2 lots I <br /> Proposed New Legal Description and Parcel Sloe: <br /> Acres: O aril 922 <br /> (If p arrt I i%to he surs("ed.p rus ode preliminary map. Sec attached for prdiminars map requirements. <br /> c <br /> Proposed ACCC%111 to publk road.: :".3titrt Aclarr15 take Road • <br /> Proposed access to public waters to hc prosided l'IN: N <br /> 11 <br /> ----....., <br /> If yes.describe acccss:__ <br /> - _ .... <br /> Mi _____„4N.. ..-"•..,___ <br /> gnon re of Owner: Date. <br /> OI <br /> argoai ft Of trnner: <br /> paw I <br /> ). Awe panel rower Zoning Reqsureyrients:' les No <br /> ?I` <br /> > Duel parcel require"a SurkArv.° Yes No <br /> sa. 1...) <br /> ..... l'er1.10 appla-odon„fee+tuhfrutted' ID Amount S r:4 Recap,r (f‘ <br /> __ <br /> ., <br /> 14,...-..ciir%ss it h Rfili Property I.ister Veit No Date- 1--. <br /> —_— 6--"' <br /> If Pot,exploits <br /> AppticatWn: Amortised ,' Denied Reason for Denial.. <br /> Date: <br /> , ) <br /> 7 g 2c9oc7 <br /> - -- - _ <br /> ________ <br />