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OCT-14-2015 15:29 WAGNER SURVEY 7158664206 P.002 <br /> Fees(must accompany form). <br /> Burnett County Subdivision Permit Application Subdowstonu/oStevvy 550.00 <br /> and/or Pre-A lication Form Survey of Existing Parcel $50 00Aoi <br /> PP Subdowsionu/Survev $200.00+550.00/lot <br /> Owpcf, /' Ii • <br /> Owner: t; fu k `Y l f�O�b P il�w: �y ill,rzv�1 + i�1C+�i 0. Jr htii 'a <br /> 7 <br /> A <br /> Address: a7O �P,.j o.n A V . S Address: �O l(0 1JQ 1 nt pis VP S <br /> Z <br /> i Wisp. . 4ijiSr 1�►2�_�,'' _�_LnNBaAU�15ri'YIAI SSS//� <br /> Phone: ----_�_ Phone:cc <br /> Parcel Information <br /> ,T-35/-oa9,c F'i <br /> tS-3s/-c7oovo O <br /> Parcel IDN: p7-C3.7 t7c_y/-i{� •v c cYr-C/eco Section��Townshi Range 1(a L <br /> Original Description(or attach copy): B Q py - <br /> t J t V r5 L 1 E fun <br /> > �R--� , <br /> Current Zoning: Floodplain t'/N:�_Wetlands 1'/N: A) _Lalce/River Class: <br /> Name of Water Body: M-t Y (OCA d k 0—1-mane k Shortland Agreement/SIPS VIN <br /> ., Farmland Preservation Y/N: Managed Forestry Law Y/N: X/I <br /> u <br /> New Parcel Information D <br /> Proposed New Legal Description and Parcel Size: f�Pz, i C-5 nny, a-5 l xnom_ <br /> Acres: <br /> (1f parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: ¢aC1`S4 i /t 4 <br /> s <br /> Proposed access to public waters to be provided VIN: <br /> If yea,describe access: <br /> Signature of Own Date; /D <br /> Signature of Owner �` 2/' Date <br /> 8 <br /> 9 <br /> 'r Does parcel meet Zoning Requirements? yes NO <br /> A <br /> 1r Does parcel require a Surrey? ►es No <br /> 5' <br /> 7Q i> Permit application fees submitted? ❑ .•f mounr S Receipt <br /> r ❑ Reconciles with Real Property Lister Yes No Date: <br /> Y <br /> n <br /> CL If not,explain: <br /> x <br /> 0 <br /> a — <br /> Application- Approved / Denied Reason for Denial: <br /> Land Use: Date: <br /> TOTAL P.002 <br />