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Fecs(must accompany form) <br /> Subdivision sv/o Sumo): S50.00Burnett Count Subdivision Permit Application Survey offxistingrarcct•. Sso.nonot <br /> and/or Pre-Application Form or Map Review Form Subdivision w/Surcy: S20000 i Sso.txtnot <br /> !mss i <br /> Beth Forest& Diane Forest owner Grant Buck& Rebecca Buck n 3 <br /> Owner: 4iiwerr r <br /> 3308 16th Ave S. 20460 Doetail Dr. 7, o <br /> Address: <br /> Address: <br /> Minneapolis, MN 55407 Grantsburg, WI 54840 <br /> 612-327-1961raa_van@ymail.com <br /> Phone: _ Phone: <br /> 1 <br /> Original Parcel Information <br /> 37 19 <br /> Tax 1D 4: 07-002-2-37-19-28-4 04-000.011100 Section_ 28 Township—Range <br /> O <br /> Original Description(or attach copy): <br /> see attached survey a • <br /> t ; <br /> RR3& Fl N Wetlands YIN: N Lake/River ClawN/A <br /> Current?,Doing: Floodplain YIN: M <br /> N/A Shoreland A reement/S1PS Y/N: N/A <br /> Name of Water body: >; t-' <br /> Farmland Preservation Y/N: N/A Managed Forestry Law Y/N: N/A - <br /> New Parcel Information <br /> Proposed Ness Legal Description and Parcel Size: see attached map, moving lot lines via Certified , <br /> Survey Map, no new parcels being created ,i �. <br /> C. <br /> Acres see attached map <br /> , <br /> (If parcel is to be surveyed,prosidc preliminary map. See attached for preliminary map requirements.) <br /> • <br /> Proposed access to public road: town road frontage& existing access easement <br /> > • <br /> k <br /> Proposed access to public waters to be provided Y/N: N "' <br /> E <br /> If yes,describe ace a: 04 <br /> s..1\ vt <br /> ..Signature of Owner: 0 k l v Date: 9" 1 - g �\)\ <br /> Signature of Owner: `► Sr"--Q..t - Date: et-I- -22-, <br /> p Fee Rec: <br /> w Does parcel meet Zoning Requirements? Yes No /oe r 1.42—' "a Check#: <br /> Does parcel require a Survey? Yes No C ,l,L <br /> If R. ,3 7 6, <br /> F <br /> `id <br /> Reconciles with Real Property Lister Yes No Date: $ <br /> rn <br /> If not,explain: - <br /> r <br /> Applicatio : {Approved Denied Reason for Denial. <br /> Land Use. Date: <br /> , z9_A„,e,_e_s_ =)---------. 9/0 2.02.E <br /> t <br />