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I ccs(inust accompany form)' <br /> Burnett County Subdivision Permit Application SubdmsronWoSurvc% 55000 <br /> :iurveN of Exisung Marcel: Sip 00/lot <br /> and/or Pre-Application Form Suhdivrsion w/Sunev. 520000 t S9,00/lot <br /> Owner: !]ezyJ + Noferrr t7 • bctk -Buyer: - <br /> �1 A <br /> Address: �7y71) (j) Icy\V\ t � i �)C I�(3 Address: E3 <br /> 1A)e 61111 LIZ .5/8`/3 a <br /> Phone: l02" 3feU " V/ /&-4J Phone: <br /> Original Parcel Information <br /> 1 <br /> Parcel ID#: 91 tido a yG /(o fJ`S v"3 GAY //t Gd Section 22 Township yu 4 Range tJ <br /> 11 0 <br /> Original Description (or attach copy): 6�pw, 4e <br /> A <br /> �z7`17y IJ onrs f S Rd <br /> Current Zoning: 492 Floodplairkf-VN: I WetlandCj�1N: Lake iver Class: <br /> Name of Water Body: Co nr.of 'S Q_ Moreland Agreement/SIPS F/N; <br /> Farmland Preservation V0-:2-Managed Forestry Law , <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: 3 7. 2 q <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided V/N: <br /> If yes,describe access; kj <br /> Signature of Owner: Date: <br /> Signature of Owner: Date: c <br /> e <br /> � Uars parcel meet Zoning Requirements.' 3 es No <br /> N � <br /> Does parcel require u Sumer{' Yes .No <br /> e <br /> 0° Y Permit application fees submitted? Amount$ -y-� �-�--� <br /> ��.C� Rec•eipld_ � <br /> �. ❑ Reconciles with Real Property Lister Fes No Date: <br /> m <br /> 0 <br /> a If not,explain: <br /> A <br /> n <br /> O <br /> 1 <br /> a — - <br /> m <br /> Applicatim pprovet G n Reo4 for Denial: <br /> Land Use: Date:__ <br /> BURNE T COUNTY <br /> ZONING <br />