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SEP-21-2012 16:26 WAGNER SURVEY 7158664206 P.002 <br /> roes tmon acrompany aamt: <br /> Burnett County Subdivision Permit Application SOdivislonw/o sumey: sso.00 <br /> Survey of Existing P I'" -0) <br /> and/or Pre-Application Form subdmhionw�sn ev: szoa.ao+aso.00aot <br /> Owner: <br /> 980 L `/,ee�hAI Buyer: vo <br /> .e <br /> )1 /1 ELealvog Q v2 <br /> Address: Address: � <br /> 6,1 ru,!Lt 0?N 5.6114 P <br /> Phone: (o hl- !09d - 539 9 t3 <br /> Phone: <br /> 56&140 PhAjt0A1 A4X4 <br /> rte nal Parcel Information <br /> 0�03��'y��l Z�5 <br /> e-6-&4;-411000 <br /> Parcel ID#: O <br /> / Section 4y /�Township Range 15vV <br /> Original Description(or attach copy): t6 7- / e 15m V S 109.E lSL, ,Z <br /> T <br /> m Current Zoning: fe'e�1' FloodplalJON: Wetland(9N. / . � <br /> Lake/River Classification: Name of Water Body: C t/ C-, <br /> r � <br /> Shoreland Agreemt or SIPS 49 Farmland Preservation Y/6_Managed Forestry Law <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel She: Vs <br /> Acres: <br /> (lf parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> op access to public road:. 3&.1s50 J �L4 arzlV <br /> Prosed d <br /> Proposed access to public waters to be provided YQ < 9.3 <br /> If ves,describe access: R ; <br /> G- <br /> UI <br /> Signature of Owner: ` L6 T xf 225L Date: �fo� �j <br /> a - � <br /> 0e Signature of Owner: Date: <br /> D Does parcel meet Zoning Requirements? Ye - No 6K- 12-1 6Gcr-9-- <br /> 9 <br /> D Does parcel require a Survey? Yes .- No J / ✓ x <br /> 1211 _S <br /> Permit application jeeg submitted? / Amount S 300• op Receipt# <br /> I <br /> d <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: --- <br /> ppI <br /> N <br /> Applicatio . Approved l enied Reason for Denial: <br /> Load Use: - Date: A�-a5-/a <br /> TOTAL P.002 <br />