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form <br /> Burnett County Subdivision Permit Application s bdivision w/ooStury y: 550 .000 <br /> Survey of Existing Parcel: 550.00/lot <br /> and/or Pre-Application Form <br /> Subdivision w/Survey: 5200.00+550.00flot <br /> Owner: gbS2twt Art-4 Kea-Le-7z_ Buyer: Sa 6 E tri t►L-cj <br /> Address: 4711)2- gEra-rn sF.g` 1b Address: ?V Bev( 23 5 3 <br /> tA.iir3ft,5Tk3rL- It 5¢$93 j?tt/EIL r.4465 , Gill S4022., <br /> Phone: <br /> Phone: <br /> Original Parcel Information <br /> Parcel ID#: ��.r f "411 SectionTownshi p 3 E Range /S' <br /> ` <br /> Original Description(or attach copy): [„ / aqt- <br /> T O{� �i�3 nit f'SL/� e—s <br /> U° p.(,. to 9 t`Jer� AA, 2/7 5-13 <br /> Current Zoning: Floodplain YIN: <br /> P Wetlands YIN: y Lake/River Class: _i✓4. <br /> Name of Water Body: 5k55 t:,¢*E Shoreland Agreement/SIPS YIN; N <br /> Farmland Preservation Y/N: /tf Managed Forestry Law Y/N: /J <br /> New Pareel Information <br /> Proposed New Legal Description and Parcel Size: L e-r / z 0 G.-o T <br /> o F Ate-1,./ C C.5.tit. -e>r To /3 t^.sn4' -,tr23 <br /> ' o Om.�-t en— Fel &Xt5ri.v6 lvbu.t'Q .a.39 e.4 v-L .T <br /> Acres: .f.,3¢ Gor <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: p.../ <br /> If yes,describe access: d. <br /> Signature of Owner: <br /> Date: <br /> Signature of Owner: n <br /> Date: <br /> B <br /> Y Does parcel meet Zoning Requirements? Yes <br /> Na <br /> N n <br /> 0 Y Does parcel require a Survey? Yes No <br /> a <br /> 0 <br /> D Permit application jees submitted? 0 <br /> Amount S Receipt# <br /> t- 0 Reconciles with Real Property Lister Yes No Date: <br /> If not,explain. <br /> A <br /> e_ <br /> Application: Approved / Denied Reason for Denial: <br /> Land Use: <br /> Date: <br />