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Fees tmust a compam fomi) <br /> Burnett County Subdivision Permit Application SubdinisionssoSuney. S;000 <br /> and/or Pre-A lication Form Sun ecoftiristl ss000iS,i <br /> Pt' Subdw>)nn%s SSun ur%e%es- S'_00 00 :Si(',li0(uI <br /> 01%ner: BuNer: 0,11;aan w Ci&A Cmc e(- _ <br /> Address: O Cys p Ave- Address: 7&31 C oua ,A, R d a <br /> lLir.��t / L� -Y 830 <br /> � + LLc� t� � SV 630 <br /> Phone: 2/3-- V/0- / (.002 Phone: <br /> Orivinal Parcel Information <br /> Parcel [D#:� oay-o7-Yo-/�/9's (eU- oaaWSection / cy ToAnship yJ Range- A.6 <br /> Original Description (or aaach copy): y o i _ <br /> Yellow f,�� g, kelt 3�5 .50' v w �h.s f l.of o7 Csr" y o P_-5- <br /> Current Zoning: Floodplain Y/N:_,L—\\'etlands Y/N:_A/ Lake/River Class: <br /> Name of Rater Body: /V/ /1 Shoreland Agreement/SIPS 1'./N: <br /> Farmland Presenation 1'/N: A,/ \lanaged Forestn• Lae Y/N: {� <br /> New Parcel Information <br /> i <br /> Proposed New Legal Description and Parcel Size: JS <br /> i <br /> i <br /> Act,-s: <br /> (If parcel is to be sun eyed,provide preliniinan map. See attached for preliminary map requirements.) <br /> i <br /> I Proposed access to public road: <br /> Si <br /> Proposed access to public waters to be provided 1•/N: R <br /> If yes, describe access: <br /> CC <br /> Si¢nature of Owner. ' "/� _Date: — r -- <br /> Signature of Owner. —_ _ Date: <br /> ? Does parcel nteet Zoning Requirements' Fes No ° <br /> A <br /> a � Does parcel require a Sun•ei'' Yes NO <br /> I <br /> Permit application fees suhnntted:' i,nu:;rt o co Receipt= _ <br /> D Reconciles with Real Property lister Yes -- —No <br /> If not,explain-- - ------ - ----- --- — <br /> Application: pprov Denied Reason for Deuial: — — --- <br /> --- 2 2016 j <br /> Land L's e: /Z3 z0/ Date: <br /> SURNETf-MUNTY <br /> ZONING <br />