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MIOUK bUtW4Vibmaa merteaA14144,o, <br /> Property Owner(s) 0 81 <br /> Address E Phone - 7 0 <br /> / 730.2.0 jtiir -re <br /> DePeeeleFeur/Contact Name ter eee . . t7 <br /> Address di. ,„ - S' 9 0 4„,0"‹. Phone <br /> / !/ <br /> location of Property 61 es <br /> • 7 <br /> township map block lot <br /> 4 1 <br /> Zoning 41, AL Fire District e <br /> A A .Alle <br /> Watershed Impervieus Surface. <br /> Joint Planning: - *177w' Carl:br° School. District elOr • <br /> State Road Number A/04 Name eft ar4 _41, Type <br /> Private Road Class .00 <br /> Do you plan to build the road before final approvail <br /> or secure construction with a, Security document? <br /> Utilities: Public Sewer , ity System Septic Tank iceory**- <br /> Public Water Comunity Water Well <br /> If on a septic system, the Health Department must examine all existing and peaxnetial <br /> building sites on lots shown on the plat, <br /> Total Lot Area N!5- Number of Lots <br /> Lot Norbert Size of Lots: Structures (proposed or existing) : <br /> et <br /> arn111......1.111MMTPIMIMAPPY ANIMINIM4Lalk040.1111111111111.1 .411114. 4 A. <br /> (We) hereby ceztify that I (we) have read the above information and that the information <br /> I (we) have supplied is accurate to the best of my (our) knowledge. I (we) understand <br /> my (our) application is not complete and cannot be approved inaess all required informatio- <br /> and material has been provide& <br /> „coe <br /> Vat= Signatu a <br /> Data Signature <br /> Filing Fee # of Lots Fee Private Road Fee Other Fee <br /> Total Fees Date Paid <br />