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JUL-12-2010 16:26 WAGNER SURVSY 7/60664206 P.UU2 <br /> Fee(muss samer.y form): <br /> Burnett County Subdivision Permit Application Subdivlsian w/o Suncy: S50 DO <br /> Survey.(Paining P <br /> and/or (Pre Application Form ` �S�.Jbdii,kia'nwtStirve :/s:oa.ro.ssom'`�owa <br /> Owner: �11W1` �11�7�-�/ dl d J/)�•��'/ <br /> n / 9 <br /> Address: / 23 /i rdl11z/ �� Address: 3 <br /> 5i1u,, , 11/i rYg7� <br /> Phone: 7/ 5- 1 9- dad Phone: <br /> Original Parcel Information OCvi <br /> Parcel IDN: sJrqq// qq r loon Township ��Range_/yr✓ o <br /> Original Description(or attach copy): <br /> >. _ <br /> Current Zoning; 9-3 Floodplaln Y6-. Wetlands VC- T <br /> LakdRiver Classification: Name of Water Body: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 5 (( C/ZL �✓ <br /> .a <br /> Acres: 5 <br /> (If parcel k to be surveyed,provide preliminary maps. See attached for preliminary map requirements.) <br /> Proposed access to public road: d 49 / lie <br /> c <br /> Proposed access to public waters to be provided <br /> If yes, describe access: <br /> —,Signature.(Owner:_ 'J(_`r-!�_ _ �m ffeA \ _ Datrro��s=/..3 33 <br /> W <br /> a: Signature of Owner: Date' n <br /> o • <br /> D Ooer parcel meet Zoning Requirements? ��— as NO - <br /> 7 3 <br /> m i <br /> -.9-t <br /> a <br /> D Does pared require aSurvey? 7No bSj <br /> Permit applicationfea submitted? []. Amount$ aReceipt s/r/Zr„YD oo b <br /> G <br /> ❑ Reconciles with Real Property Lister Yes NO Date: A) <br /> s <br /> If not,explain:. I <br /> 0 <br /> U <br /> Application: proved Denied Reason for Denial: <br /> 11111L 16 2013 <br /> Land Usc �j l�G Date:��rr�s/s�i -4 <br /> / DVns�El� t�lViy <br /> ZONING <br /> _ 70?AL P.002 <br />