LS73-09'Form #5-66 LOT SPLIT APPLICATION
CITY OF FRIDLEY
FOR CITY USE 'DNLY
Applicant's Name
APPLICANT t / 1(�PC�E'T ���C���1VV _
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�✓ r, Lot Split =
ADDRESS• 7 6)�� r�,y�c�� 'LL'J 1'�'i�y 3
�+ Street City Zip Code Date Filed:
a, TELE�HONk. # Feer Receipt
•N Home Business Council Action: Datf:
REMARKS:
PROPERTY owxER(S)
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ADDRESSI'S )
Q' o Street City Zip Code
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+3 40
Street City Zip Code
o a H TELEPHONE #(S)
Home Business
43 v 00
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Property Location on Street
or Exact Street Address (IF ANY)
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�1 Legal Description of Property:
Reason for Lot Split:
Total Area of Property sq. ft. Present Zoning Classification
The undersigned hereby declares that all the facts and
representations stated in this application are true and
correct,
DATE: SIGNATURE
BELOW FOR CITY USE ONTY (Set,,xv 'ersv stdo for additional instructions)
PLATS & SUBS; Date of Consideration
Remarks;
PI.ANNING COMMISSION; Date of Coneideration
CITY COUNCIL; Date of Conei4erotion -
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