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FEB-27-2013 17:50 WAGNER SURVEY must 715866420torm76 P.001 <br /> tm lw-saaaenY : <br /> Burnett County Subdivision Permit Applicationsaaai. is wo sa er: sso.00 <br /> and/or Pre-Application Form s m:si�� s i:mn'o+i`s000nm <br /> Owner: DOJ WS Buyer: <br /> Address: <br /> x8586 RZ tV10ei VF dress 3 <br /> �Gn i �yB <br /> Phone: a - 312 <br /> Pbone: <br /> O <br /> 01-0lz 2-1/6 /y- iy-/5 Ori�innlParcel Information <br /> �[ ,/ � ����� c� <br /> Parcel ID 4: l5-(,5`t�6�CbD-1- Dlot �7 Township 7drr/Rangef ry <br /> 4 <br /> Original Description(or attach copy): <br /> b A6ief- VIZLA6E <br /> > ZUtS 59,5'7, 66 fikdIJAfj Pion/ G <br /> J O <br /> Current Zoning: PUL Floodplain� Wetlands xo <br /> LaheIRNer Classification: Name of Water Body: }Vy\y <br /> Shoreland Agreemt or SIPSyfN�. Farmland Preservation Y&Managed Forestry Law Yi� _ }(� <br /> Kew Parcel Innformation �/n /'� JIUY� <br /> Proposed New Legal Description and Parcel Slee: C Smy A t� 1 + 3y`I 3DS <br /> Acres: <br /> (If parcel is to he surveyed,provide preliminary map. See//att�ffached for preliminary map requirements.) <br /> Proposed access to public road: id WrAll NUJ V.f/ <br /> Proposed access to public waters to be provided Y : <br /> If ve6,describe access: <br /> Slgnafureof Owner. Data <br /> 0e Signature of Owner: Date: f] <br /> ➢ Domparcel meet Zoning Requirements? Td <br /> > Deas parcel require a Survey? =Yey�- No \ O <br /> L L <br /> 3 D Pvml(appl(casianfeer submitted? PrI Amount _J�.n� Receipt: , p <br /> ❑Reconciles wit].Real Properly Lister Yes No Data: SO <br /> I <br /> If not,explain: � <br /> Cj �I <br /> Application: Approved I Denied Benson for Denial: <br /> U, <br /> Lund Use: Dole: <br />