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BURLEY PLANNING & ZONING DEPARTMENT Lot Split Application 2020 Parke Avenue Burley, ID 83318 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Name: APPLICANT Address: Phone / Cell: Lot #1 (Lot to be split) 1. Parcel No. (i.e. RPJ10702070041A- obtained on your tax information or from the County Assessor’s Office). 2. Copy of deed showing ownership including legal description (Obtained from the County Clerk’s Office). 3. Current Lot Size: 4. Address of Lot (if known): GENERAL INFORMATION 5. Zone: R-1 C-1 R-2 C-2 R-2A C-3 R-3 S-1 R-4 6. Record of Survey: Shall be in conformance with Idaho Code, Title 55, Chapter 19 and contain additional information outlined in the Lot Split Checklist. 7. Other such information as may be deemed necessary by the Planning & Zoning Administrator. I hereby certify that I have familiarized myself with the rules and regulations with respect to preparing and filing this application, and that the information I have provided is accurate to the best of my belief. Signature / Printed Name of Owner of Lot #1 Date REPRESENTATIVE Name: Address: City: Phone / Cell: