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Fres(must accompany farm): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: (50.00 <br /> Sarveyof F,wti.&P.c1: f50.00n0t <br /> and/or {Pre-Application Form Subdivision w/Survey. MOM S50.00110t <br /> Owner. _ n -/J` w <br /> Address: 8 /16) Pl:eort.O Iw Address: <br /> co st , h; 5yy3 <br /> g6 - 866- y9?') <br /> Phone: 7��7 "p/t4y 83�10 <br /> Phone: <br /> z <br /> W <br /> Or'einal Parcel Information <br /> f, oO2 621>4y�o �r/ <br /> Parceling: D9'� /8- '7 Section 06 Township3gNRange Lb b'✓ O <br /> F <br /> / � ' <br /> Original Description (or attach copy): G- L. <br /> r <br /> 9 <br /> 9 <br /> Y Qp rJ <br /> - <br /> Current Zoning: k i Floodplain Y/N: Wetlands YM: <br /> Lake/River Classification: Name of Water Body: <br /> New Parcel Information � // <br /> Proposed New Legal Description and Parcel Size: Lo T V. <br /> Acres: <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: pbtlr -0 /lf/�C'� <br /> �,(`� C <br /> Proposed access to public waters to be provided Y& - <br /> d <br /> If yes, describe access: <br /> N Signature of Owner: Date: <�`Gb —u��Y <br /> e <br /> Signature of Owner: nNi )IP u.FALIAL- _Date: ghbl - 3 <br /> > Does parcel meet Zoning Requirements? Yes No <br /> a <br /> m > Does parcel require a Survey? Yes No <br /> J <br /> 6 <br /> > Permit applicationfeer submitted? ❑ Amount g Receipt# � <br /> 'o h' <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: - <br /> Applicati Approved nied Reason for Denial: <br /> Land Use, Date, O /O Zc'YZ <br />