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Burnett County Subdivision Permit Application Subdivision w/o Survey: 550.00 <br /> Survey of Existing Marcel: 550.0011at <br /> and/or <br /> //Pre-Application <br /> Form Subdivision w/Sary 5200.00.S50 00/1.1 <br /> Owner: 17-1 rrr111e-a�Orl�' ? l.IA/Cl d, &Q oBuyer: n <br /> Address: o� Ly /Li&TZ 110061 Address: <br /> '7 1L&6Secru; it); �`�`39-3 <br /> Phone: l I�- t /-6- I sG l <br /> Phone: Z <br /> Orieinal Parcel Information <br /> o� Ozd 1 y0-llo-33 505 DUl-015000 333 /DRange /!o d'✓ o <br /> Parcel ID#: Section Township <br /> Original Description(or attach copy): �� Gsr, -/r q3 V D� c <br /> V s <br /> Current Zoning: Rk Floodplain Y WetlandsYi <br /> LakelRiver Classification: Name of Water Body': /s-Lf tH /5c-- <br /> Shoreland Agreemt or SIPS 09 Farmland Preservation Managed Forestry Law <br /> New Parcel Information <br /> / �y <br /> Proposed New Legal Description and Parcel Size: R <br /> • // G I <br /> Acres: <br /> (If parcel is to be surveyed;provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters;to be provided Ye e <br /> If ves,describe access: <br /> Signature of On'ner. Date: <br /> q. 2,7- 4 <br /> Signature of Owner: Date: 3 <br /> — o <br /> - c <br /> 'r Does parcel meet Zoning Requirements? Yes No <br /> o a <br /> 0 <br /> Does parcel require a Survey? Yes Na <br /> as <br /> J Permit application fees submived? ar, Araoury 3 gl2o, nn Receipt# g � <br /> s ❑ Reconciles with Real Property Lister Yes No Date: p <br /> c P <br /> F If not,explain: - O <br /> n <br /> Application: Approved i Denied Reason for Denial: C) <br /> I <br /> Land Use: `-'L. . Date: /2//zA'9// <br />