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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application <br /> Subdivision w/o Survey: 550.0 <br /> and/or Pre-Application Form I Surveyof Ezisling Parcel:000.00/lat <br /> � // Subdivision w/Survey: 5200.00+SSO,OOIIot <br /> Owner: 4f 4rl (PI L4-t 7'7=07 fL Buyer: ;y <br /> n <br /> Address: °j/3 t�Guknee.CAniN L CoufTN Address: <br /> 13t_A�I PJC r Mfj SS4-49 <br /> Phone: SI '" 2 6 - .�•2 i Phone: <br /> Original Parcel Information <br /> t4-2 — o-Z•zoua 4 <br /> Parcel lD#: `�f'L'a-/o e0 Sectlon�Township 4•/ Range <br /> Original Description(or attach copy): /+VTS It 1 1 -4, OF 4VAr- prr✓rIS <br /> A(,2 D r Ti e.J <br /> y Current Zoning:��—Floodplain Y/N:--.ZS(_Wetlands Y/N: All _Lalce/River Class: <br /> Name of Water Body: Shoreland Agreement/SIPS YIN• <br /> Farmland Preservation YIN; Managed Forestry Law Y/N: <br /> New Parcel Informatiott�KJh j1� ,3133 <br /> (I�.�r3 ��.•T tea <br /> Proposed New Legal Description and Parcel Size: 7307W_ !� <br /> lir 3 rA!•f-n 1 t^, rtt t! T- �yra^ pwzpeke- Ofh SG/s-Drw�.- <br /> A- &1/ &.afs6 l��F+e I alLw�st-- 607` 6kXt Acres: ✓w• 7/� <br /> (If parcel Is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road:��s rte_ ,dSS PT T� e_P/ E G�4oaf OF- <br /> Proposed <br /> Proposed access to public waters to be provided YIN: jAJ_� <br /> �1 <br /> If yes,describe access: g 1 <br /> Signature of Owner: Date: <br /> Signature of Owner:.AIAL41 Date:_ <br /> C <br /> ➢ Does porta!meet Zoning Requirements? Yes No F <br /> x <br /> a ➢ Does parte(require a Survey? Yes No <br /> yam/ <br /> Permit appilealfon jeer submitted? Amotuu$__-�rZReceipt#- — <br /> �. ❑Reconciles with Real Property Llster Yea No <br /> n <br /> Application• pprove / Denied Reason for Denial: <br /> Land Use u�— Date;,-�/ �-// Z�Cl <br /> eo4 <br /> My 27 2016 <br /> f <br /> BURNETTCOUNTY <br /> ZONING <br />