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L.LO t, MANAGEMENT fex,651�3618J0„ Apr et zuus U:atpm ruuyuut <br /> r. Fees(must accompany'am): <br /> Burnett County Subdivision Permit Application subdivisiopw/osurvey: $50.00 <br /> Survey of Existing Parcel: $50.001lot <br /> andfor Pre-Application ]C'or'm Subdivision w/Sttrvevt 5200.00+$50.00t1ot <br /> &b&-f J �m �z t <br /> Owner; /aU 0//�� Buyer: ro <br /> Address: QC <br /> o W 2d #81)Address: <br /> QW�` qA*-n, Alin 59112— <br /> phone; <br /> ag//zPhone: 7/ -y97Phone- <br /> )456'32- <br /> hone:)5C'3Z .:�-74. & Original Parcel Information <br /> Parcel TA#: D �8-3333 ` 7� Section .�O Township Sq ,/Range�(y✓lf 0T <br /> Original Description (or attach copy):. MVu'/ <br /> �o7T' 3 CS ir, V to >n/87 <br /> /� dl <br /> Current Zoning- 2^ floodplain Y� W tlandsY� <br /> Lake/River Classification: Name of% ater Body. <br /> Shoreland Agreemt or SIP$ N��Farmland Preservation Yti �M aged Forestry Law Y Nt <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: � ) <br /> Acres: 5.o3 <br /> (If parcel is to be surveyed,provide preliminary map, See attached for preliminary map requirements.) <br /> Proposed access to public road: �l Gt.c-+c a� <br /> Proposed access to public waters to be provided Yh�� n <br /> 115 <br /> If*es,describe access: (� <br /> r <br /> q o <br /> Signature of Owner; Rata: `4 a 7-d ,p <br /> Signature of Owner: Date: � ! <br /> 3 <br /> 0 <br /> D Does parcel meet Zoning Requirements? Yes No n <br /> a - ➢ Does parcel require a Survey? Yes. No <br /> Permit applicatton fees subm.11 l?/ fl Amo uit S te ' D�Receipt# <br /> a Q Reconciles with Real Property LiseT'� tee— - No Date: <br /> W <br /> If not,explain: t1� <br /> i <br /> c7 <br /> Al <br /> J <br /> Application: Approved / Denied Reason for Denial: o <br /> d <br /> Land Use: pate: <br />