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Fea(must enompany form): <br /> Burnett County Subdivision Permit Application Sandwv i.nwtaSurvey: $50.00 <br /> Survey of Existing Psrcel: S50.00Aot <br /> and/or Pre-Application Form <br /> ,, suhdivisionw/Sarvcv: Sz0o.o0+S5o.a0nm <br /> Owner: 10I l✓h LR BUU�/� Buyer: <br /> � A <br /> Address: Pig, '60X �/OX 7 / bAddress: 3 <br /> GUebs�"c�, GUr �y893 0 <br /> Phone: Phone: <br /> CA <br /> Ori *nal Parcel InformnI,. <br /> yo <br /> DO <br /> Parcel ID g: O7"OlO" Z-YO-IPJ' 3I' �� 0�. Section Township YDI Range 11'k✓ O <br /> Original Description(or attach copy): <br /> D <br /> 9 <br /> V <br /> b <br /> Current Zoning: Floodplai Y Wetlands YIN: 1 <br /> LaketRiver Classification: Name of Water Body: <br /> New Parcel Information 1 / <br /> Proposed New Legal Description and Parcel Size: C s�» (/ , <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for prelli/iminary map requirements.) <br /> Proposed access to public road: �OrC i O/L4 lf6_a _ <br /> Proposed access to public waters to be provided �j•. <br /> O <br /> If yes, describe access: S <br /> ii Signature of Owner:_ (I�r�-C [)u.n( Date: <br /> 0 <br /> 00 Signature of Owner. n <br /> Date: 3 A <br /> 1 <br /> > Does parcel meet Zoning Requirements? Yes No ,'4 Q y Q tV •, X� <br /> > Does parcel require a Survey? Yes No !✓A q'5-13 a <br /> 6 () I <br /> ? > permit application fees submitted? ❑ Amount E Receipt k p <br /> 'o � <br /> n <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> O <br /> If not,explain: <br /> d � <br /> Ut <br /> APPlicatiaDenied Reason for Denial: p <br /> Land Use: f /rte Dale: <br /> 611 <br /> v <br />