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2Sa <br /> l'i w(nano accompany lima <br /> Burnett County Subdivision Permit Application Stdidi,,Y,a°n�"u Surrey: 5D.04) <br /> S4wscy of Fsisting Parcel: S.50-00 lot <br /> and/or Pre-Application Form or Map Review Form subt►ir,.it.a E, Suney: s200.00 -SSt).tl(tlot <br /> Owner: Laura tvii..:Laugh!; Si& ti 1.7, Buyer: Karen E`r- c <br /> v <br /> Address: ,:i; i ci t. Address: 12 2:. _ .__ :v: .. <br /> Dcnb.rry. W; 54830 Coon Rapids, K41`,1 55448-2668 .W gfi <br /> Phone: 7"-`''_5 7 7--7 63 2 Phone: 76 3---2 4 2-- 5751 <br /> Original Parcel Information <br /> -.I"rat ID it: 95 Section �! ..low reship _ ua� W <br /> Original Description(or attach coPy). Pori '- i a t : -.f, . <br /> C <br /> h. <br /> Current Zoning: R,R 3 Floodplain 1.7N: Wetlands%I V: Lake/Riser Claw N <br /> Name of Water Body: N.A. Shoreland Agreement/SIPS Y/N: N.A. f , <br /> Farmland Preservation YIN: ;N %lauaged Forestry Law 1., : •. <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: L<-",- i of a rt€'W C SY. <br /> b <br /> Acres. - . _ !,`C ie:5 b <br /> I <br /> (If parcel is to be surveyed,provide preliminary map. Sec attached for preliminary map requirements.) y� <br /> Proposed access to public road: - +`- - +(WY L <br /> C <br /> Proposed access to public waters to be provided Y/N: N ?� <br /> If yes,describe access: <br /> Signature of&alter 0. -r ' c s� +`ti Date: 2 24) �� <br /> ci <br /> Signature of Owner: Date:___ -_ a <br /> i Does parcel meet Zoning Requirements' 1 lei No = <br /> Fee Rec:Z50• <br /> Does pan l riquirea Stiff- i:' }rr .'4i, <br /> ; <br /> % <br /> Reconciles with Real Property Lister Yes No Date: - (I) <br /> 'l. Q <br /> If not,explain: L <br /> may a <br /> ‹.3 _7 <br /> n NH <br /> Application- Ap ov Reason for Denial. i <br /> o <br /> (.and 1!se. Date: ? 3 w <br /> 3f zoz 3 CD <br /> -- <br /> C <br />