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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision wio Survey: S50.00 <br /> Survey of Existing Parcel: S50.00.'lot <br /> and/or Pre-Application Form Subdivision xvi Survey: S200.00}S50.00/lot <br /> Owner: j:•.1,r4 A . L Aer a Buyer: 13r,.a.A e.. Z Mt It544 (JOC-aN <br /> Address: 31 qLl S F 1 ^� / <br /> I � 1�-c�� 1 0 Address: P J . 1lY lg <br /> (.-)e-Ls1-cr (.... S L 5 3 S k <br /> r7 �G c. I tU l s $ �� kJJ <br /> Phone: !LS�4q- 7T 7 Phone: (P 3 - )(p o - 00°0 ‘)z) <br /> Original Parcel Information IV <br /> p?-alb- 3f-t.-3),-S oc-otx,-o2too .� <br /> Parcel ID#: O?-O�{o-�-3'�-is--3•Z-s o1-- t.O - Srection Sok Township 3 7 Range ,,, <br /> // <br /> CD <br /> Original Description (or attach copy): t.o4. .s 1 J.. i-G GSM Po. Li 33?, (1;,I. 2 3, <br /> PSeS ,)j.y --2.lS 1 Lc..lct ,a 6r,v1'4.ti-e4" .-4.4.(pr J«. -:w Jai TTUY4d4 ,4 <br /> g ) C L j� r i f �� <br /> / N a! t �.7 e ' J t d�`i 7�L� 1 i. W r.r Lk'(nJ/\j•1 ,Zv' <br /> z . Current Zoning: Floodplain YN: 1 ' Wetlands YN: !v Lake/River Class: P 14 <br /> z <br /> Name of Water Body: t�/i Shoreland Agreement/SIPS YN: A cD- <br /> Farmland Preservation Y/N: A. Managed Forestry Law YIN: 14/ ) <br /> it <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 4 4s41 -a. ' <br /> -0 ti2 4.14.4, . c..a A. sA z Stp4n/ crow Lau 1I j Cat? M . 30?? . <br /> + " � 1 ( • <br /> ler Atit }11ft�1erC� c �i, �r TG Acres: • J 3 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: t46,1 Pi 0 v <br /> Proposed access to public waters to be provided YO <br /> If yes,describe access: <br /> 7� . <br /> Signature of Owner: 4,./..,e4 � ahA Date: $- 26. - ,2 rip <br /> Signature of Owner: D n <br /> Date: c <br /> B <br /> -c <br /> ;-• Does parcel meet Zoning Requirements? Yes No 61g COO ( 7 -, <br /> N <br /> a Does parcel require a Sarver-? Yes tVo <br /> - E. oO W <br /> v. > Permit application_%essubmitted? 0 Amount$ 2--C-r- Receipt# Cj <br /> ® Reconciles with Real Property Lister leap No Date: l\-a3-off oa .N)-__ <br /> U <br /> =' If not,explain: CA <br /> N <br /> n ` <br /> O <br /> J• A <br /> Application: . 1--novetl / enied Reason for Denial: <br /> Land Use: // 30 oa ZQ,ate: • <br /> Ar_A 1 GS ft71 / 9 6 dome, once, ee., Gou v' CaSe- <br /> i s t^e... d iAei. -7-h i t Du t'r,f wi// , 6e p G e f <br /> o-F 4 e, 64 v CS 1/1 , <br />