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Fees(muss occompany form): <br /> Burnett County Subdivision Permit Application salaivisiaawmsarvey: sw.00 <br /> Survey of Existing Parcel: f50.00nm <br /> /�.� and/or Pre-Application Form sabdivisloa wn sarvev: siyoo�oo+sso.odnot <br /> Owner: /r//ATTJ"I/A5 PuTZ/�� Buyer: 'W vjd�-61 v n LLe R- <br /> Address: 6565 df'L /VAdcress: 8/Y5 5yat '�7- C 3. <br /> i��L,� (L , 7/v� 5y��o Cif/e v 1'1Z <br /> 1zL o/� <br /> Phone: 71�/- �o,/V /(09� Phone: <br /> 0�'bZ6'2- O-lIu-02-`J Original Parcel Information <br /> y og-666Y3Uoo pYYCtb � � <br /> Parcel ID#: Q7-UZD-Z-Yb-/!- 5- <br /> A5 , .�n� Section "2 Township yb/VRange1&W/ O <br /> F <br /> 7- / CSn+ V Z <br /> Original Description(or attach copy): 14 3 P/vJ �- <br /> > L6T l C5m VLo P 23/ <br /> 9 <br /> 9 <br /> n <br /> ° Current Zoning: ko e �- qq Floodplain(ON: Wetlands�YN: <br /> Lake/River Classification: eL.- Name of Water Body: Fa u� ZAXe U <br /> New Parcel Information / 11 // a <br /> Proposed New Legal Description and Parcel Size: oz• D T Lr�J/n Vfj �9-33 L <br /> Acres: / 3 V <br /> (If parcel is to be surveyed,provide preliminary / �/ <br /> map. See attached for preliminary map requirements.) <br /> Proposed access to public road: /Y L(-�OL11- �iC.Q_ eL dam+ <br /> v O <br /> Proposed access to public waters to be provided YQ <br /> If yes, describe access: <br /> N Signature of Owner.� . ,-/- vD Date: <br /> e <br /> � <br /> a0 Signature of Owner• ! -Date: 7 cn <br /> 3 <br /> 0 <br /> i Does parcel meet Zoning Requirements? Yes No <br /> Does parte(require a Survey? Yes No ✓��/� ',ie• <br /> 7 Permit applicaiionjers submitted? $d Amount .1 )1 / Receipt# <br /> c r❑ Reconciles with Real Property Lister Yes No Date: b' <br /> If not,explain: O <br /> Application. Approved / Denied Reasonq f�or�D/f9nial: <br /> �/' 2G/ c �4J , Ce f�7m ( d Pc � <br /> Land Use: Date: /t7'')-j-/3 <br />