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11-2006 07:24 WAGNER SURVEY 716(3664i0G P.002 <br /> Fees imuu accompany form) <br /> Burnett County Subdivision Permit Application sum,vismnw/osunc% ssuoo <br /> SurveyorF.rtsungparcel f3000Ao1 <br /> and/or Pre-Application Form Subdts,smnwlSuryev s200oo4ssn(M)nm <br /> Owner: KeAviel4k ct Jo; 5 Ai f cx, _ Beer <br /> Addreaa:.Rf,2 Sou'41.usmr11 'ht Address: <br /> 3 <br /> rane,on <ods, ►}t Al S SGUq l <br /> Phone: tin S/-380-93d 1p Phone: 65 <br /> A <br /> Orieinal Parcel Information �= <br /> 07•C/.i'-,?-yrvS.dB-S tf-lr[•-CBiJ�CY' n <br /> Parcel ID M:07-cy;?-y(`i?,db<J i S-ler-c•aacr0 Section�Township y� Range <br /> Original Description(or attach copy): c2 7779 t Cat' $Ag QJ i l ear ! <br /> At f <br /> Current Zoning:�,b aFbodplainEN: Wetlands 1' �_{ River <br /> p Class: <br /> Name of Water Body: i e 1-t. K C. Shorelond Agreement/SIPS Y�11V: <br /> Farmland Preservation a Managed Forestry Law Y d <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: 2(r <br /> (if parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: �.,K S 4i"i R C <br /> Proposed access to public waters to be provided Y/N: d,V I;^ <br /> If yes,describe access: <br /> Signature of(Tyner: Date: <br /> Signature of Owner. Date: <br /> Does parrei meet Zoning Requirements? lies No <br /> i Dyes/wreel require a Jur:e)? Yes NO <br /> Lj <br /> i Permit applicationfees suhmille'r, 1 :I mount S. l t Receipt <br /> ❑ Reconciles with Real Property Lister / Fes No Date:-,V <br /> ate: ,gy <br /> a VN1NVL <br /> If not,explain:,__ <br /> n <br /> n <br /> 90 9 Ndf <br /> Appli�Approved_/-Denied Rensoit for Dcnial:_�/ <br /> Land Ilse`%�� <br /> r Date: _ <br /> 5(4 6aL . Ua�: 00-16 -of qpp�►� �z�z°�G� <br /> TnTAT, P.002 <br />