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SEP-I8-2016 23:55 WAGNER SURVEY 7158664206 P.001/001 <br /> I'm(must oxompamtom): <br /> Burnett County Subdivision Permit Application &,b6,-o;=,tostmcy ss000 <br /> Sunry of ExIst Marcel: s5a0alot <br /> f ( <br /> /y� and/or Pre-Application Form Subm.uro%/S�u. szoo.00-Ssoa <br /> .00,t <br /> Owner. 1[xO 1 Se +c; e. Buyer: <br /> Address: (og25q Mectdcwlc1.Ck Address: <br /> n C Grow✓' M) SS3l�9 <br /> 0 <br /> Phone: 76:3- y 2 S�'/S 70 Phone: i <br /> Orieinal Parcel Information <br /> o7_W,2-ga k5_o9s lT fc4S-cxoY000 r� <br /> Pareel ID11:07-0LZiS,b195 Sectioa�Township yo Range � <br /> OriginalDescription(orattachcopy): se1-};Rm Sur\ Add -It] Vop4e.c- <br /> V11 CL Q 4-04 S Sy °I 5-,5- <br /> Current Zoning: Q u b Floodplain Y, \I'ettaods 1' i _L kdRiver Class! <br /> B Name of Water Body: Shoreland Agreement/SIPS /N• <br /> c <br /> Farmland Preservation\f(N:J Managed Forestry law 13S 1 _ <br /> New Parcel loformation / <br /> Proposed New Legal Description and Parcel Sae: .,)jEA_j <br /> m.a.ke a Ids `tre I let- l <br /> Acres: L D 7 <br /> (If parcel is to be surveyed,provide prelitainaryf map See attached for preliminary map requirements.) <br /> Proposed aeras to pubtie road: Q K)S7 i n to S <br /> Proposed access to public waters to be provided\'/N: '•'• <br /> If yes,describe access: 1,7 <br /> p / c <br /> Signature of Owner: 14 <br /> Dale: / r! <br /> Signature or Owner: Date: c <br /> 3 <br /> c <br /> > Does parcel meet Zoning Requirements? Yes NO <br /> > Does parcel require a Sun•e.V' Yes NO a <br /> °0 i Permit application fees submitted? amount S-5 y l 4 i Receipt=_ <br /> 0 Reconciles with Real Property Lister Yes No Daw <br /> 0 <br /> a if not.explain: <br /> R <br /> R <br /> 0 <br /> a <br /> Application Approved /.berried Rnate for Denial: -- <br /> Und Use: <br /> Date: (�. <br />