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ree.mrosraeeampmry orm>. <br /> Burnett County Subdivision Permit Application sand.isma arrs�yey: S5000 <br /> Sarse),,f e.,amk Par«f sso.amdm <br /> and/or Pre-Application Form Subdivkien w/Survev: Szdaon 1 SSMUVIb, <br /> KAru)zyd .i—. Lnnrc.J <br /> Owner: Ki IZMIr 13, LAIZ50,J Racer: <br /> Address: I I (.­9 Vi MC 0,10 LAKE fw ,%dd,css: 3 <br /> i <br /> LUGI H/[ 54 Sr3 <br /> Phone: 7/S 327 4907 Phone. <br /> Original Parcel Information <br /> Parcel lD q: 03417 Z70-1 3ry Section Z-J "rosvnshie 3 7 Range Id <br /> C <br /> Original Description(or attach cop)): A(r"wCD <br /> c Curren) Zoning: R2 Z Floodplain}•/N; N Wetlands}'/N: _lake/Ricer Class: NA j <br /> 9_ _ <br /> Name of Water Rudv: NF1 Shortland Agreement/SIPS Y/M NA r{—' <br /> Farmland Preservation Y/N: /✓ Managed Forestry Law Y/N: Al b(� <br /> Ness Parcel Information <br /> Proposed Nps Legal Description and parcel Size. WaLO c-n i -/ -/ Sir 2O—, M `nr <br /> 3 Ac/zCr t7 � 714caE t LCrS <br /> Acres: /O r' <br /> (If parcel is to be surveyed,provide preliminary map. See attached for pre insinar'map requirements.) <br /> Prnp.,cd access to public road: p../ j./, /L av;VO GNKG /ZJ '� l <br /> Proposed access to public wafers to be provided Y/N: /s/ <br /> If ves,describe access: y�j <br /> O J <br /> Signature of Co,ner: [)age: <br /> Signaturcof Owner! — — Date: <br /> i Doev pnreel meet ZmdngReyuireruenlsP Yes No <br /> IT /0.13•,3 e <br /> s <br /> _ . Does pnreel r'rquire n Sur'revP x Yar � No <br /> Peron appliro,ion fees.snOmhied? (/JI ., Amount S.JL( )- Rezrip,l: <br /> ❑ Reconciles sv ilh Real ProperlY Lister Yes No Date <br /> d <br /> 11 nM,e%plain: <br /> z <br /> c <br /> Applicaliu . Approse Denied Reason for Denial: I <br /> Land Dse: .lam-l� Dale:_�URNElI�.,O" <br /> ZONING <br />