HomeMy WebLinkAbout19-00167 - APPLICATION - 36 N 2nd W - Lot SplitLot Split Application
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City of Rexburg d�
ti ,� REXI3URC
n Phone: 208.339.3020
-IuwdLILb , 11 8 0 www.rexburg.org Fax: 208.359.3022
Lot Combination Fee: $50.00
APA 1 0 2019 Fee(s) Paid: Yes/No
Submittal Requirements
p 2dt�tVIA' FAb'vow I ❑ Legal Description - for new boundary
❑ Affidavit of Legal Interest: If you are the property owner's agent, you are required to provide a notarized
letter from the property owner authorizing submittal of this application.
❑ 4 copies of application and supporting documents
G Digital .pdf copy of application and supporting documents
OWNER OF RECORD
Name: Address: Pb Til ZBIa
City/ST/Zip:. { Telephone: 2-b- 17 lPLL-3
Email: C M V C Gata Iroa,i I - LOM Fax:
APPLICANT
Name: Zft!)Vl ugg+hx^ VA Address: ?-C f � 1,141 P Vy0 fir
City/ST/Zip: 1Q oyLy Z4 WA (AP 4�;'4 40 Telephone: Z -0R �iif Oh44-
Email: f-r�a Ulm Fax:
SUBDIVISION INFORMATION
Subdivision Name:
PropertyAddress(es) 77lo WIY+M ? VJ� WtclF-
ExistingZoning:
Intended Land Use (Circle)
Lot Types
Residential
residential, single-family,\ �u�imer ' 'ndustrial
Number of Lots Acres
Dwelling Units Per acre (gross/net)
Commercial
Industrial
Common (Landscape, Utility, Other)
Open Space
Total
I understand this application is sub' to acceptance by the City of Rexburg upon determination that the
application is compAt.
plica fee is non-refundable. All information, statements, attachments, and
exhibits included wation s bmit al are true to the best of my knowledge.
Signature of AppliDate moi
Lot Split Process
1. Complete application is turnerin and fees are paid
2. GIS Review
3. Quitclaim Deed recorded at the County — Deed the new boundary for parcels back to yourself
4. Communicate record number to the City
5. Boundary changes are made on the GIS map
Affidavit of Legal Interest
City of Rexburg
35 N. 10 E. Phone: 208.359.3020
Rexburg, ID 83440 www.rexburg.org Fox: 208.359.3022
State of Idaho
County of Madison
I, P60
Name
Sv9Ar Glfy
cid
CITY OF
MBURG
n/ Av.>M n
Address
-F-dao
State
Being first duly sworn upon oath, depose and say:
(If Applicant is also Owner of Record, skip to B)
A. That I am the record owner of the property described on the attached and I grant my
permission to: (3, -0 LP�aa %I r
Name Address
to submit the accompanying application pertaining to that property.
B. I agree to indemnify, defend and hold Rexburg City and its employees harmless from any
claim or liability resulting from any dispute as to the statements contained herein or as to the
ownership of the property which is the subject of the application.
Dated this �day of l a 120
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—
Signatu're
Subscribed and sworn to before me the day and year first above written.
°APtt- S •R0S� •,'s
06 . ••. L Notaloublic of id o
Residing at.
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f'•; Nn. X1�g.•'•�O,•' My commission expires:
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