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Burnett County Subdivision Permit Application Sabdmsionw;o San'cy: $50.00 <br /> Sunny of C.isling Parcel: 550.00nat <br /> //'' and/or Pre-Application Form Sabdi�uionw/San'ev: S200.00+550.00/1ot <br /> Owner: WJ 1l/ �n <br /> 41"'1 /l M W Buyer: <br /> Address: �/35 5 ✓/L�-r;(.f, 5�/L(irL� Rs/' dress: 3 <br /> loam �Kl t y, 7o S" ,sae <br /> �rn Phone <br /> 09 OlZ Yo-/5 /5 5 /5-'/t` a arcel�iemInformation <br /> 07-blZ- 2- YD-Y5-/5-5 <br /> Parcel ID q:d9-O/Z-1-Yo-/5-/5-_i 9a`10 1/ 600 Section-L-FL TownshipRange <br /> Original Description(or attach copy): <br /> 4/ /yta/ /0 6, /o / S 02- <br /> �iCdU �'e 'A0 <br /> or <br /> Current Zoning: PFloodplain Y/:� Wetlands Ycqo _ <br /> Lake/River Classification: Name of Water Body: <br /> Shareland Agreemt or SIPS Y `:Farmland Preservation Y�Dlltffllged Forestry Law Ye <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> /, j <br /> Acres: V, <br /> (if parcel Is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: �" <br /> v <br /> Proposed access to public waters to be provided YK <br /> If ves,describe access: <br /> Signature of Owner: Date: __ T <br /> ' c <br /> Signature of Owner: Date: <br /> > Does parcel meet Zoning Requirements? Yes No <br /> \ # <br /> 2 > Does parcel require a Survev? Yes No <br /> o' <br /> r. <br /> 7 Permit application jeer suhnnitted.' W Amount S- Z__Receipt k <br /> n ❑ Reconciles with Real Property Lister Yes No Date: <br /> c � <br /> F Ifnot,erplain- <br /> � <br /> bc,Applicatio Approved Denied Reason for Denial: <br /> Land UDate: <br /> r � <br />