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<br /> <br />6"'1 P2L~ ,AYU~ r t1,mF>1 ~ :111L J./147 ;d ~~ <br /> <br />-Xnlte rvi[[e 1880 Main Street . CenteTwu[e, :My.{ 55038 <br />'EstaEi[isfi"ea 1857 CITY OF CENTERVILLE (G5 429.3232. 'fa>;. (G.'U) 429.8629 <br />~PLlCATION FOR ~O'l I'iPLIIfOT COMBINATION <br /> <br />'\. / '''-J( Anyadditiooal costs incwred for <br />LOT SPLIT/LOT C.OMBINATION: ..6..... FE~:j~O + engineering,legalfees,publlcationor <br />other requirements <br /> <br /> <br /> <br />.IV tJpJA.U, ~rdf,/V' <br />/p~A)e,~ <br /> <br />o~c..\\!'~ <br /> <br />SIZE OF P ARCEL(S): .'fit't(J lues <br /> <br />PROPERTY OWNER: GeM"}) /(,/(1'1'" <br /> <br />FEE OWNER: q..~ j <br />ADDRESS: c:.~tJ<)?-t!J 't1 A.~ {;i <br /> <br />APPLICANT'S INTEREST IN PROPERTY: <br /> <br />PHONE#: f05f-/J.6-'t1N <br /> <br /> <br />FEE OWNER <br />LEASE HOLDER <br /> <br />)( <br /> <br />REASQNFOR~QUESl~ bu.,11 NeuJ k,.foAf~ I" <br /> <br />/,,:'f" , ,~: l~_.;:, _ :,-?,":,:,/~,.>",_, ,/t:,'!fcl f' <br /> <br />/ <br />!~';;;/', <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 />even if the ontcome is denial. <br /> <br />Signature of Property Owner <br /> <br />Signature of Applicant <br /> <br />Date <br /> <br />Ii.A//f.I/Ilt {II L'J /.J /. <br />'rr' /tA14 r&Jfk.t!tfJ, Ll.C <br /> <br />f'~ M,A~ .6/ <br />(,Q/~ /,t(,. ~m() <br /> <br />A-EZ)6",~ ~iM'Prl.!;.tr:. <br />