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Fm I==,1-1 <br /> Burnett County Subdivision Permit Application saem.wanwtasa re,: $50.90 <br /> and/or Pre-Application Form subdvlei9 wl ng nno...-S5o0anw <br /> Owner: 6uera,ld µ/ ms Buyer: <br /> Address: /3y Qy�k'QAddros: <br /> ,ascan, 71Un 55308 9Y5D P <br /> Phone: 713 - 269 -434y Phone: V <br /> pp Orlaloal Parcel Information <br /> Parcel lD a:07"�lO '�-3cI"/�-ZJ'y RZ-�n�Townshl 39A1 Ran , <br /> '" � n Ind � <br /> Original Description(or attach copy): _AIPV 5E a <br /> Lor 5 051n /VD Y377 Y 23 �3yq n <br /> Current Zoning; Rle.3 FloodplalnY® Wes4ndsY6 <br /> Lake/River Classification: Name of Water Body: 1- <br /> New Parcel Information n^ � <br /> Proposed New Legal Description and Parcel Sire: 1-/) T 5 - <br /> o f /VIE J4c - C 550 d P �t7- <br /> Acres; 5. 55 <br /> (If parcel is to be surveyed,provide preliminary map. See attached forpreliminary map requirements.) <br /> Proposed access to public road: _ /'invty 'lr' O /L <br /> GY <br /> 7L o Gts/ <br /> Proposed occas to public wastes to be provided Y&'•. Q <br /> If yes, describe access: <br /> Ur <br /> 1 j <br /> Signature of owner: " Date• /'Z / 2n/3 <br /> Signature of Owner: 1 De[e:fZ /Z Zel3 <br /> D Does parcel meet Zoning Requirements? �es� No G K Yu Jeysd S <br /> D Doer parcef require o Strrvry? Yes' No <br /> a <br /> ➢ Permll appticalonfeer subnused? Amoum$ -!5b, U ReceipeN <br /> t <br /> C <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> If not,captain: <br /> Appli ion: Approved / eoted Reason for Denial• <br /> Land Use: Date: <br />