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Fes(musl accompany form) <br /> Burnett County Subdivision Permit Application Sobai%isionw;bSur%c% s5000 <br /> Sunrn Of Eruting Parcel: S50.00,104 <br /> and/or Pre-Application Form Subdi;isionw/Surae, S20O.DO,S5000,lot <br /> Owner: Geofae, Li.n.defmQo Bayer: <br /> Address: I(n y '7 /_=ve ro rPe n k I'�. Address <br /> z � <br /> 512 ooWX 51YECl <br /> Phone: (R 12 - (O 70- I a;L0 Phone- <br /> Orieinal Parcel Information <br /> 07-oa01-.7-3q-111-lq-.2 01-C:co-0 t(ocx>�) <br /> Parcel ID Section15—Township 3q Range <br /> C <br /> Original Description(or attach copy): 4o+ (0 `t �/ S YV\ U- 19 P ill <br /> 7 Current Zoning: Floodplain 1etlands Y�� _Lake/River Class: <br /> Name of Water Body: it/ A Shoreland Agreemeat/SIPS 1'/N- it%A <br /> a <br /> Farmland Preservation 14 2 )fanged Forestry Low YIN:., j <br /> New Parcel Informatioti Q— <br /> Proposed New Legal Description and Parcel Size: <br /> 02 L)f cs ph �o rJ c s rv% <br /> Acres: l o, y <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: :7 <br /> m <br /> Proposed access to public waters to be provided 1'/N: <br /> If yes,describe access: <br /> Signature of Owner: JD 60 <br /> Q ` _ Date: pck- (I- n�p ( <br /> \ <br /> Signature of Owner _ U�:�d a� � Date L I ki <br /> 0 <br /> 3 <br /> e <br /> > Does parcel meet Zoning Requirements? )es No � <br /> > Does parcel require a Sure►•? Yes NO <br /> a <br /> Permit application fees submitted? Amount S Receipt= <br /> O Reconciles with Real Property Lister Ves No Date: <br /> 0 <br /> e <br /> G If not,explain: <br /> n <br /> n <br /> O <br /> G <br /> Y <br /> Applicatio Approved / nied Reason for Denial: <br /> Land Use: — Date: 913t'? Z-016 <br />