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Burnett County Subdivision Permit Application Subdivision w•;o Survey: S50.00 <br /> Survey of Existing Parcel: S50.00aot <br /> and/or Pre-Application Form or Map Review Form subdivision w Survey: S200.00-S50.00 lot <br /> ) ftky1ee'inaI2 Owner: Buyer: c <br /> Address: �� L 1� S+ 5 I ) Address: 7 Z <br /> 2 0 <br /> Ill illYti 101104nil rv0 <br /> Phone: C2 I /If 3 _t 1 - Phone: .f l <br /> Original Parcel Information { <br /> b pQ <br /> Tax ID#: 221$2 229(b 3,Z29`6 U— Section Township 44 Range 1 (e, NI <br /> Original Description(or attach copy): ..n''SS ) t Z. 1 3 310CR , ' i2xL <br /> ( r;4 Atai k.,1.),-, +0 01.4,1 beyea <br /> I rCurrent Zoning: Floodplain Y/N: Wetlands Y/N: Lake/River Class- <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> rhs- <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Information ic <br /> Proposed New Legal Description and Parcel Size: J <br /> -erJ <br /> qe PA pc,.t. <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> I <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: ri <br /> If yes,describe accesS L /// 4 ) <br /> l/ -/C2 SignareofOwner Date: <br /> Signature of Ownerk Date: /0 hO .23 <br /> Fee Rec: <br /> . Does parcel meet Zoning Requirements? Yes No = <br /> Check#: 1 i`J <br /> f <br /> Does parcel require a Survey? Yes Norn <br /> D <br /> z <br /> C <br /> rn <br /> rn <br /> Reconciles with Real Property Lister Yes No Date: Fi <br /> J <br /> inni <br /> If not,explain: D 0- <br /> O C = —I <br /> Application: aproved- enied Reason for Denial: c CD C N uoU�f <br /> m w N <br /> Land Use: Date: mmcooC inn! <br /> 00/zoZ3 <br /> �.. JJ <br />