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DUrIICll %-000ty 3000IV131UII s-efuut nNpucauvss ��,.•,. <br /> mM1ryorex��dagearcd: sso.00nol <br /> //`y <br /> and/or Pre-ApplicationForm I SIIbZIVI51on WI SanSe S700.00S50 Mot <br /> Owner: liar VI(eAVN Buyer: s <br /> w93 3 Lo Rd fl <br /> Address: Address: - <br /> OrJel'F W 1 5`480/ °t <br /> � a6 - �a98 <br /> Phone: Phone: -) <br /> Original Parcel Information W <br /> �t QZ- Ul' 000- 9itpO , 7q u <br /> Parcel to H- (01-02 y- �_3'7. ly y Section � Townsbip✓ ?t✓ Range �/W <br /> O <br /> Original Description(or attach copy): �* e my� <br /> NE 5E tr N tU' SE <br /> a <br /> c <br /> 9 /� <br /> m Current Zoning: %2 3 Floodplaia6v- Ves ._ Wetlands ye.) <br /> LakelR)ver Classification: Name of Water Body: [p <br /> Shoreland Agreemt or SIPS YA_Farmland Preservation)&—Managed Forestry Law XN�— G <br /> New Parcel Information 1/ <br /> Proposed New Legal Description and Parcel Size: 5r� V • <br /> Acres: ��• �'� <br /> (If parcel is to be surveyed,provide preliminary map. See attached forpreliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided 16) IS- <br /> If <br /> If ves.describe access: <br /> Signature of Owner: Date:_ y.7 4" t q <br /> Signature of Owner: Date: c <br /> e <br /> E. <br /> ➢ Does parcel meet Zoning Requirements? Yes No - <br /> ca <br /> Q. ➢ Does parcel require a Survey? Yes No O <br /> O <br /> J <br /> > Permit application fees submilled? ❑ Amount S Receipt a I p <br /> m ❑ Reconciles with Real Property Lister Yes No Date: 1� v <br /> e d <br /> a <br /> � If not,explain: � yj <br /> o I <br /> ii p i <br /> �i <br /> Application• Approved,/'Denied Reason for Denial -� <br /> 1 <br /> Land U Joion -Jnr Date: <br /> J-J j AA ' Gc,7"/0 l'- 0- <br /> 7'/�Oq Pdr7r.v w� y /, 17 yule SJ/I Se/ � <br /> ECOVE D <br /> JUN 11 2014 <br /> BURNETTCOUNTY <br /> ZONING <br />