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12/10/2014 17:56 FAX 715 245 7764 A C F SOIL & SITE EVAL. 4002/002 <br /> Burnett County Subdivision Permit Application sobdivislcn u o survey: s50.00 <br /> Survey oflixisting parcel: 550.00,1ul <br /> and/or Pre"Application Form� Go� � Subdivision wi Surver. 5200.00+S50 00A)i <br /> P <br /> ver•: <br /> nn- - B>IptlT ,,� ,a <br /> Address: d`�!� 7'Q u C-SDA� � �/ Address: ,�� u C�� /J�"�" 34 <br /> D S L'2 0 l4 /it/ i w yDoo <br /> Phone. <br /> e7_eD 8 3 g- /y-p5 orieinal Parcel Information Alarcel EDN: Section �- Township 3 0Range ILMI <br /> Original Description(or attach copy): LTJ f19 Ll�T OF <br /> a <br /> ro <br /> a i <br /> Current Zoning: Floodplaf Wetlands IN <br /> L■keiltiver Classification: Name of Water Body: <br /> Shoreland Agreemi or SIPS Y6�--Farmland Preservation Y6anaged Forestry Law Y <br /> New Parcel Information �jr7 <br /> Proposed New Legal Description and Parcel Size: C!J �' •5 , 7� <br /> Acres: 04 rx <br /> (If parcel is to be surveyed,provide rchrninary map. See attached for preliminary map regniretnenls.) \v <br /> Proposed access to public road: <br /> w <br /> Proposed access to aters to be provided Y/l�I% <br /> vv <br /> If ves,describe a cess: J <br /> y <br /> Signature of OnoerC*_--- 5 Date: <br /> Signature of Owner: Date: o <br /> e <br /> a <br /> D Does parcel meet Zoning Requirements? Yes No <br /> L at <br /> a ➢ Does parcel require a Survey? Yet No <br /> 7 Permit application fees submitted? Amount S Receipt q <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> m <br /> a <br /> If not,explain: <br /> r <br /> G <br /> Y <br /> 6 <br /> N <br /> Application: pproved 'Denied ReaAoo for Denial: <br /> Land Use: Date: <br /> ve ---- <br />