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ccornPany <br /> Burnett County Subdivision Permit Application SuhdivisionJo/o Survey: $50011 <br /> and/or Pre-Application Form Survcynl'IixistingParccl: $50.00Iot <br /> R( Subdivisioaw/Survev: $200.00+$Sp.ppgot <br /> Owner: � i cf- "Debfu IJQic Civ <br /> Buyer: <br /> Address: SX 7 J-0t11 i j Ave_ Address: <br /> _l11 i hn? '��,ti�n i IMV 7 S 3yS z <br /> / o <br /> Phone: Phone: <br /> Original Parcel Information <br /> Parcel ID#: p7-c l.?-� c5 [cYCI5CctSection „2& g Township C Range— /,,5 <br /> O <br /> Original Description (or attach copy): /ef Ze CS{Y\ <br /> 0 <br /> 9 Current Zoning: I / Flood tat Y\ <br /> a <br /> P' . �: Wetlands Y ,�____kl,ake%River Class: <br /> m Name of Water Body: _SdKd Lt <br /> Shoreland Agreement/SIPS Y/N: <br /> Farmland PreservationM <br /> T, <br /> anaged Forestry Law Y�N <br /> New Parcel Information � 5- <br /> Proposed New Legal Description and Parcel Size: �C✓C�' /►� 0 <br /> Acres: to C 7 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: �K I's 4 i r, q <br /> v <br /> Proposed access to public waters to be provided Y/N:� ro <br /> If yes, describe access: <br /> J <br /> Signature of Owner: Date: <br /> Signature of Owner: Date: n <br /> 0 <br /> s <br /> Z Does parcel meet 7.oning Requirements? Yes <br /> No � <br /> N � <br /> o. <br /> Does parcel require a Survey? Yes No <br /> vo <br /> Y Permit application fees submitted? Amount S Receipt q <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> m <br /> o <br /> ° If not,explain: <br /> A <br /> n <br /> 0 <br /> 0. <br /> H <br /> Application- Approved enied Reason for Denial: <br /> Land Use:-. 3 7 ZO/ Date <br />