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Burnett County Subdivision Permit Application <br /> and/or Pre-Application Form <br /> PP Subdin., <br /> �'Lo2i it W�fll/C2 <br /> Owner: 9 nn �2 Buyer: <br /> Address: 30/R la �d n Address: \ <br /> rw��/rEk' wl �y�I3 \ opo <br /> Phone: /I�r ��J'- �� �3 Phone: \ <br /> Original Parcel Information // <br /> 7 C OJ"OA� Q p /d��RangeW \ <br /> Parcel ID q: O/-QZ. Z-yQ-/°/-J9-J Section I/ TO n O <br /> Original Description(or attach copy): - ' U� L. .5 � <br /> _.. _ _ _ _ .Current Zoning: A 3 -Floodplain Y iQ• W¢tlnnds Y - — - - <br /> a <br /> Lake/River Classification: Name of Water Body: <br /> ShoranFparcells <br /> .Agr SIPS 6t 17armlaud Preservation YO Managed Forestry Law Y <br /> New Parcel Information 1 / <br /> Description and Parcel Size: -CSm <br /> V1 �3�`�-3-22 <br /> Acres: 5. 65 <br /> eyed,provide preliminary map. See attached for preliminary map requirements,) <br /> „p Proposed access to public road: <br /> C <br /> Proposed access to public waters to be provided Ye <br /> If Yes, describe access: - " - - - TF- <br /> Signature of Owner. Date: -1 <br /> (�-�Ir7 GJ <br /> Signature of Owner: Date: — - f] <br /> 0 <br /> 9 <br /> ➢ Does parcel meet Zoning Requirements? yes No , OC -r, J/`11 'e <br /> .6. _17_1) .; <br /> ➢ Does parcel require a Survey? �j" No <br /> `i' Perm it applicationfees submitted? Amount$ "Q,7„(� Receiptk i19 <br /> m ❑ Reconciles with Real Property Lister Yesk1 <br /> No Date: W <br /> A Ifuet,e:plain: <br /> O 1 <br /> 2013 <br /> Application: Approved Denied Reason for Denial: <br /> S <br /> U <br /> Land Use: ��J(!<— i <br /> Dam: 16 .;2.S-(3 <br />