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MINOR SUBDIVISION APPLICATION <br /> r <br /> 4V : <br /> Property Owner(s) e -mr , <br /> Al-/Conta t Name . „ . . , te <br /> Address 40 ' <br /> Phone te ^,,, <br /> A../, <br /> Location of Property <br /> hi B block lot <br /> Zoning ilk - F <br /> Watershed A. ke ^ II pervious Surface es " I ., 90 <br /> / <br /> Sc <br /> State r , ., , <br /> Private Road /ass Na <br /> Do you plan to build the rc before final approval , 41,0 s <br /> or secure onstra ct <br /> . with a security document? <br /> Utilities:,, jc �! <br /> r <br /> w7y 't t1.c�. Tank <br /> If on a Community <br /> p system the Eea ,.th Department must examine all existing, and potential. <br /> building sites l on lets shown on the plat, <br /> Total Lot Area",. <br /> w / �' eta """ / <br /> Lot e Number: Sire f Lots: structures <br /> (proposed or existing) ' <br /> '14 R./-7 AG .0 <br /> g <br /> I w <br /> I Owe) have sUpplied is accurate to the best of my (our) knowledge, I (we) understand <br /> (We) hereby certify that I ( e) have read the above information and that the informatlon <br /> my (our) -application is not complete and cannot be approved unless all required information <br /> and material has been provided, ,, <br /> OF <br /> ... c? ,S14141 9111 Y <br /> data <br /> Signature re <br /> Date Signature <br /> Filing Fee of is Fee Private Road Fec � Other Fee <br /> Total Fees Date paid <br /> „0,...» _... _..,a. .............mm . <br />