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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/oSurvey: S50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application Form or Map Review Form Stibdi1on w/Survey; 5200.00+550.00/tot <br /> S14114/0.i €i,doc <br /> Owner: Jarrow 4, C.4e.A.:,4 os Strerd!C 501,Hilt 14A-146Xove i <br /> Address:/!77 e ,v: AZO Address: M Cpu/ - PS o <br /> 4.4.261 0N( -- , svi- Sher (u)1 5-y// 0 <br /> Phone: 701 -/y—,yry Phone: i?3- 150- -Si?1 <br /> Original Parcel Information <br /> Parcel ID#: 3J}(6o1 *441160 Section 2g- Township 40 Range l4 <br /> Original Description(or attach copy): L.,0'"S 1 art A Z C.,e-a w► #i- 416' i <br /> 1 <br /> 0 0 <br /> r) <br /> to1 <br /> Current Zoning: QZ` Floodplain YIN: Ota%L-E,Wetlands Y/N: /.1 Lake/River Class: 5 fu <br /> 7- <br /> ,o l.:iL Name of Water Body: Klat is u-'--- Shoreland Agreement/SIPS Y/N; CO <br /> 0 <br /> n Farmland Preservation YIN: Managed Forestry Law YIN: <br /> 1. ) f <br /> New Parcel Information <br /> IQ 7� <br /> Proposed New Legal Description and Parcel Size: l' 1 d GM v,S <br /> 'kr e oS.e 't S'iv 3 o r. I r irs Carl- Cor+ (Joni tni(xv i <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) 0 <br /> a <br /> CO <br /> Proposed access to public road: -15 <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: )0 <br /> I <br /> / Sugs�f-err <br /> Oignaturc of Owner. / Po <br /> / �vtJ J Date: ��~o ^�'a <br /> 9 Signature of Owner: e' /t A !. All./..0%. Date:12-c -(4-c)/ <br /> ammannommoiv <br /> > Does parcel meet Zoning Requirements? Yes No S�St'� <br /> C <br /> g ➢ Does parcel require a Survey? Yes No <br /> a s. e" L� <br /> en <br /> D Permit application fees submitted? 0 Amount$ -'�--- Receipt# <br /> ;-� t. . <br /> � <br /> El Reconciles with Real Property Lister No Date: v0-aio--a( <br /> If not,explain: lrs <br /> et. <br /> 0 <br /> y Application: .!.proved h Denied Reason for Denial: <br /> Land Use: i /0/ 7o Z/ Date: <br /> IA ' C- A/ ' CoPo%L/JA/ k I - a - celS ,' <br /> an UPGO w )9 Coxa/ p( L - <br />