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Fees tmust accompam fomes <br /> Burnett County Subdivision Permit Application SubdnisionicoSurvey S5006 <br /> Sun e} of Existing Parcel 550.00 lot <br /> and/or Pre-Application Form Subdivision%% Sune% S20000-S>000lot <br /> Owner: &M cxt.�L y /_i-,C Buser: <br /> fr <br /> Address:3G7 )S S'7,ie IZ& 35-12 7 Address: <br /> Z <br /> COX s-YL 3C-) <br /> Phone: '1/S-l05& ' 311(V Phone: <br /> Original Parcel Information <br /> a9-03.Z--7-Y/-i6-�t�-/ uN-crc, <'j/C<x, <br /> Parcel ID uw-�,ac��� W <br /> o y-o uu--�,3cc v Section Township Y �( <br /> I Range 1(y <br /> I <br /> Original Description(or attach c,py): PCI f SE AJC Kx 03lal Pa73, /,)Fl c5 rh oil p.7y7 <br /> ('CI <br /> 6/2 ,yC Cx d3ioa PS-S�? c6m Ua P/53 <br /> csm o ll Payy SE VE <br /> I <br /> Current Zoning:C_Floodplain 17l: A�_11'etlands 17N: A) Lake/Riser Class: <br /> Name of Water Body: 4)A Shoreland Agreement/SIPS 1'/l: A) A <br /> Farmland Preservation 1•/l: A) A Managed Forestry Law 1-/l: x,)A � <br /> Newv Parcel Information / p <br /> Proposed New Legal Description and Parcel Size: \/a <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirement.) <br /> Proposed access to public road: X [�7'n cr 7 <br /> � _ m <br /> Proposed access to public waters to be provided 171: 4)A <br /> If yes,describe access: ski <br /> r '- `l <br /> Signature of Owner: ( Lel,-e Date: % <br /> Signature of Owner: -" Date: <br /> c <br /> Does parte/meet Zoning Requirements.' }-es A o <br /> i Does partel require a Surre.:' Yes .10 <br /> Permit a lica/ion ees submitted.' :fntotnu S5 „_. _ <br /> L—. PP f Receipt=_ <br /> �. ❑ Reconciles with Real Property Lister 1'es to Date: _ <br /> G If not,explain: <br /> z � — <br /> Application A rDenied Reason for Denial: <br /> _ JUN 21 2016 <br /> Land Use. +w — C_ �O z9 _ Date: <br /> ZONING <br />