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05/25/2005 12:07 7156485513 <br /> HOFFMANN AND ASSOCIA PAGE 01 <br /> 1 py -x tb BkNfnG� Co. 10M CC. <br /> 51.2.51105 Re: �)oMme.n A lot �Jcs►11 <br /> 'From - RoA 6Urnwnn 649-5s13 <br /> Burnett County Subdivision Permit Application FSbdivtsion <br /> ust accompany form): <br /> ion w/o Survey: $1 0.00 <br /> pand/or Pre-Application Form w/Snrveysloo.00+sls.00na <br /> Owner: c, . <br /> Address: 42lie. St. <br /> t7 r e. '1Ca�sn r n l/J2 54s tg) Phone: -715- 1+465 --5 4 G <br /> Orldnal Parcel Information 1 0 <br /> Parcel Identification N: Section Township 3_Range 19 X <br /> 0 <br /> Original Description(or attach copy): Th E 14 0V j M s S W Z4 <br /> St:.0-t%o 2s T39_ r1- R i IA/ y b� <br /> Current Zoning: Floodplain YM: � Wetlands YM: fkj <br /> $ Lake/River Classification: 14 Name of Water Body: JA <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 1 t C cs M — <br /> L.ot 2 25 53 Aeras Ates: 40.33 Ae. <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: N/A o.e1: i 131o�R�1 t S�w��d5`e <br /> t <br /> Proposed stews to public waters to be provided YM: NIA <br /> n <br /> If yes,describe access: nom` <br /> Y-/ <br /> ➢ Does parcel meet Zoning Requiremenu Yes No <br /> Does parcel require a Survey? Yes No 9 <br /> nil <br /> ➢ Permit application fees submitted? C3 Amount 3 Receipt 4 <br /> ❑ Reconciles With Real Property Lister Yea No Date: <br /> a G <br /> If not,explain: <br /> Application: Approved Denied Reason for Denial: O <br /> Land Use: Date: <br /> 2118n.003 <br />