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ut accompany font): <br /> Burnett County Subdivision Permit A lication S, <br /> s'visina ato sw►=y; ssoub <br /> SmveylrfFxistiggF:cei�35t1.QQ/iot: <br /> and/or Pre-Application Form or Map Review Form s+ a, ►esu: szoo.0,+ssooana <br /> Owner: .-P tIn o iii a--t)a INA(,�he Buyer: \)� PO Os L A IA N '5rA10- i <br /> i <br /> Address: <br /> Address: <br /> .01rAa.•- , IA)1 54 636 I <br /> Phone: .,_( -3 Q 4---) D Q` phone: <br /> -1--. ..)e <br /> c 1 Orielttai Pared Inform:4 m <br /> Pared ID*: -7 g Section 15, :Township LI-O Range I S <br /> Original Description(or attach copy): Li24 i 10 4 1 <br /> 3 <br /> Current Zoning: Floodplain YIN: wetlands Y/N_____Lake/River Clan: 1 <br /> b Name of water Body: Sborelana Agreement/SIPS YWN. <br /> IFarmland Preservation INN: Managed Forestry Law Y/N: -K1-' <br /> j lw Parcel Information <br /> Proposed New Legal Description and Parcel Size: L a'4- . <br /> (v)tj - I COQ‘0h1-.&- Lc, I4p /LA. Its A- rL i L/ t/ <br /> Acres: 6 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preiiminary map requirements.) a <br /> Proposed access to public road. �\ <br /> Proposed access to public waters to be provided Y/N: ' . <br /> If yes,describe access:___•__�^ <br /> Signature of OwnerGrr+;r ` Date: JO/go/07'0 t I <br /> # <br /> Signature of Owner: Date: <br /> Y Does parcel meet Zoning Requirements? Xaa No <br /> Does parcel require a Survey? Yea Na `^� <br /> I ➢ Permit application fees submitted? (] Amount$ /vc • <br /> O� <br /> r Receipt# Q <br /> ®Reconciles with Real Property Lister ® No Date: \a-RIo-a.I o <br /> If nut,explain• <br /> VI <br /> Appiieado Appro ended Reason for Denial: <br /> 0 <br /> Land Use: Date: . c)(1F 1/ / 210 Z/ .._._ <br /> / <br /> UYV 2t1 OY ^ I._..p,s 1)444 edr- "1 1`)- Cr S5-$ci(,O <br /> Scanned with CamScanner <br />