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Fees Im t accompany form): <br /> Burnett County Subdivision Permit Application snndesmlw/oSurvu, $50,00 <br /> Survey of E.sietingl'arcel: S5000/Iat <br /> and/or Pre-Application Form Surd emits,w/Sarvre S20001)«550.0011et <br /> Owner: 6Le n1 Se Ii AAF L-Fr A - Buyer: 515-A0 4 SC-A1 SCII AAF <br /> 9 <br /> Address: +- S¢. LA Kr ZCp Iz.D Address: <br /> -PnNfSua4 WL S +630 <br /> Phone: Phone: SeGN 9" -50/0 015 `1/k-110') s_ <br /> Original Parcel Information w <br /> Parcel 11)#: 032 5ZZZ01 Vbo Section Zz '1'nwnship 4-1_ Range <br /> C <br /> Original Description (or attach copy): A frH C{{ Lb <br /> s <br /> y5F srM� IN LKae NI-ASS i <br /> i Current Zrming: RR-Z Floodplain Y/N: Wetlands Y/N: OKI'- Lake/River Class: ?i / <br /> a <br /> Nance of Waler f odp: Z(a L A -I= Shortland Agr emus/SIPS Y/N: <br /> 0 <br /> Farmland Preservation YIN: p/ Managed Forestry Law YIN: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size•. 'Z L-c T- G S M <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Lor I - LAKE 7 C V D Ler 2 - CAS IF MGti T_ <br /> Proposed access to public waters to be provided V/N: N iF <br /> J <br /> If yes,describe access: J <br /> O <br /> Signature of Owner: Date: Z -I V <br /> Signamra•of Owner. Date: o <br /> I <br /> 9 5i <br /> > Does parcel meet Zoning Regtdremenn? �Ye, ',,V', L !/e7v"1Gr'C �/�-�j� 5Doe.,parcelrtguh,eaSm"'v? � f� W <br /> °C D Perrnir nyplicn(ion fire mrbzirted? � Amnuru S=�cie6�Receipt# <br /> r"./.�._ <br /> 1 <br /> Recoacdes with Rial Property Lister Yes No Date: <br /> c If not,explain: ' <br /> Application: Approved / D led Reason for Denial: <br /> Land Use: Date: -S-�Z� <br />