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<br />1880 :Main Street . Centerviffe, 9vfJ{ 55038
<br />'Esta6{isfied 1857 CITY OF CENTERVILLE (651) 429-3232 .:Fa?( (651) 429-8629
<br />APPLICATION FOR LOT SPLIT/LOT COMBINATIONIREZONING
<br />
<br />Any additional costs incurred for
<br />FEE: iqC/' + engineering, legal fees, publication or
<br />~ other requirements
<br />
<br />LOT SPLIT/LOT COMBINATION: l(
<br />
<br />REZONING:
<br />
<br />DATE PAID:
<br />
<br />STREET LOCATION OF PROPERTY: MOUND T~A\L -11-[42.(
<br />
<br />LEGAL DESCRIPTION OF PROPERTY: Lon "(" 10 ~L";;' I _ T~G' S 1-\.,;>.1,,-,
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<br />s"'- < o..'t\O.c.~\...l .5 It.,
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<br />OF Ne.,/
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<br />SIZEOFPARCEL(S): N~W~ is:IL\.S ~'S(\115 5<t_l'"-r_
<br />PROPERTY OWNER: .GJeMl R~~h(\'ir'l PHONE#: 1(.,3-,'8'-1-01.,57
<br />
<br />FEE OWNER:
<br />ADDRESS:
<br />
<br />(?\~~" R...."'-\,....;~ t-'\.1r,,~R.,,-"'-b~,.-..
<br />><GSI I\Jcf \"" S'i-: AJ", Elf. .:"<- t'-1,v ,,'7>'1-1'1
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<br />APPLICANT'S INTEREST IN PROPERTY:
<br />
<br />X FEE OWNER
<br />LEASE HOLDER
<br />
<br />CONTRACT PURCHASER
<br />OPTION TO PURCHASE
<br />
<br />DESCRIPTION OF REQUEST: COMj",,,e 1'3' Sh-;f' ",f' ,-,,1'" {o
<br />w,t-\., (....<>1' <j - S..e e.d-,.I".;r
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<br />REASON FOR REQUEST:
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<br />f'r"'~<J..I... S,'\~,l--:",,-_\- -\--t~~ ,~ ~ I'"
<br />
<br />By paying the above stated fee, I understand that no refunds will be issued in full or in part, at any time,
<br />eve . the outcome. is deoi1WJ" _ ~:l '. ,.
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<br />Signature of Applicant Signature of Property Owner
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<br />8NID3
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<br />Date
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