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Fees(must accompany farm). <br /> Burnett County Subdivision Permit Application Subdivision ss'oSuney: S50-00 <br /> Suncy of Existing Parcel: S50.001ot <br /> and/or Pre-Application Form Subdivision ss%Suncv: F200.00'SS0.001ot <br /> ( Oss ner: t -A'- 8(1(c. Buyer: <br /> Address: 3Sc oft..- r-+S 4.At.JC Address: E. <br /> 7. <br /> 0 <br /> Awha r P <br /> + <br /> ,-, Ss <br /> Phone: 113‘.6). Vie_ t.+!3 Phone: T <br /> Orijinal Parcel Information t <br /> Parcel Il) 1-0,1c 10 Fj 7Ce A- Scction Tossnship Range <br /> O <br /> Original Description(or attach copy t: Loo 116 1 r.e_,,,St1v`e— is 1001 A aAC,��Oft 4o UV <br /> • - . . . tr :e c.t e. • . •r a !Ain- <br /> ' <br /> Current Zoning: Floodplain 1'/N: Wetlands 1'/N: Lake/River Class: <br /> '• 4amc of Water Body: Shoreland Agreement/SIPS YIN; <br /> Fi <br /> ;1 I <br /> Farmland Prcccrsation Y:N: Managed Forestry Law 1'N: <br /> Ness Parcel Information <br /> Proposed Ness Legal Description and Parcel Size: 1.. p A- ti C S'' . - - <br /> n--;iii‘ Z pa_r4e.1 s <br /> Acrd: <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 YIN: \ <br /> If yes. describe access: <br /> Signature of Owner: "L Date: t\‘t t. o a t <br /> Signature of Owner: i ..v ts..) Nate f cok fop A! gam. Date: 0 <br /> Does purre1 meet ZoningXcr raremcvris' }'es No /4/se' RoV <br /> -#33,co ' s�s7 <br /> Doo parcel require a Survey) res No is <br /> OD L ���' - On <br /> i Permit applrrution fees submitted) 0 Amount 5 ��� Receipt e <br /> 1 r 0 Reconciles with Real Property Lister Yes No Date: °Q <br /> I s I If not,explain: L.6... <br /> c <br /> i <br /> Applicatin �Apprcrs cel r� )enied Reason for Denial: <br /> Land Use: ' 1 Z1z//ZU Z/ Date: <br />