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JUL-31-2013 17:19 WAGNER SURVEY 7158666206 P.001 <br /> Fav(mva attwgmy form)• <br /> Burnett County Subdivision Permit Application s bdi m Wasa ey ssoao <br /> and/or Pre-Application Form Form s sm`aP' s:mL 000a s5o.aonat <br /> Owner. 490f7 N(r_� -Ph/en_ve//7*�� /7 Buyer. <br /> Address: II Z 65rC�dbyn �Cy /UAddress: 3 <br /> dzr�, W, <br /> LL ('//� 22��pp <br /> phone: 7�)�7to3� SJ:l1 Phone: tj <br /> riInal Parcel Information D <br /> Parcel IDM: 07-03114-37-18-3r� / a3DMSedon wmhi 37&' Ran e(�a"✓ O <br /> � ToP_ C <br /> `Original Description(or attach copy): J` 3�r O/' <br /> ' EX/1'lly'� /11�Jr'ItINy I� Nati V <br /> 9 <br /> a � <br /> Current Zoning: 4 s- FloodplaYy� : W,a-Ilan / T : , v�� •+ <br /> Lake/Rlver Clersifrcetiom 3 u Name of Water Body: CC.ee <br /> New Pamef Information (Z, <br /> i? 3 <br /> Proposed New Legal Description and Parcel Size: c �7 V,r <br /> Acres: <br /> (If parcel Is to be surveyed,provide preliminary � <br /> ry Seeap. Seattached for preliminary mop requirements.) <br /> Proposedaccesstopublicraed: / ^ � <br /> 0 <br /> Proposed seem to public waters,to be provided Ye <br /> If yea,describe aceeas: <br /> SaJ <br /> L W <br /> = Signature of @•'^^ ��w. `y �y`DO Date: <br /> 0 <br /> Signature of Owner: Date: on <br /> 3 <br /> > Does parcel meet Zoning Requirements? Yes No O CC Yz, o gs° <br /> > Doer parcel requires Survey? Au{ Yes No o p'C <br /> > Pernmiappllemonfeessubmlrred? tpl Amount$ J-500W Rereipt9 <br /> 3 O Reconetlm with Real Property Lister / \Yes No Date: ) l�U <br /> t Vi <br /> If not,explain: l <br /> W t <br /> Appiicatio : Approved / wiled Ruson for Denial: D <br /> Land Use: ✓ Dale: <br /> BURNETTCOUNTY <br /> ZONING <br />