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_ Pees'must accompany torm): <br /> Burrett County Subdivision Permit Application ss ivi'ia .wsamy: s5 <br /> o. o <br /> Suveyo[E.k1mgPrc": $50.00�9 <br /> .1 <br /> and/or Pre-Application Form sabddii.;siopw/Su__e�: <br /> on <br /> Owner: f 1LfQBn (S <br /> ``L <br /> Add r s: �CU r/ Address: �% / 9 <br /> �5 q qj lue.l , GU, �yS93 Gt d v,&L , lUi 61/03 ' I <br /> p n p 4 <br /> Phone: _ �I J— / / I / Phone: <br /> Original Parcel Information -� <br /> Parcel lD#: �7 Ul� C / OzZp0— P Section �:J Townshi - � Range <br /> /t <br /> ,t/�w ✓C _ g -- � <br /> Original Description(or attach copy): E <br /> 9 <br /> (d1,7&,4 djV✓�147t') <br /> M. <br /> w Current Zoning: A �— Floodplain Y& G1 <br /> Wetlanda '_'o _ (� <br /> Lal,e/River C!assifscstion: Name of Water Body: 7K <br /> Shareland Agreemt or SIPS Y Farmland Preservation Y Managed Forestry Law <br /> Q <br /> T <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: Q. U <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: UI /WA!:f <br /> Proposed access to public waters to be provided YIN: (J ' <br /> If ves,describe access: (may <br /> C <br /> Signature of Owner: Date: <br /> Signature of Owner: Date: <br /> 9 <br /> > Does parcel meet Zoning Requirements? Yes No <br /> N a <br /> '- > Does parcel require a Survey? Yes No o <br /> n m= J <br /> > Permit application fees submitted? gl Amount 5 ZSR • Receipt# <br /> sJ <br /> m ❑ Reconciles with Real Property Lister Yes No Date: (n <br /> 6 v � <br /> 1 <br /> .t If not,explain: <br /> C yy� (Tf <br /> Applicat' n: Approved /-Denied Reason for Denial: <br /> �DG17S/ !� � /✓/PHI <br /> Land Use: Date: 12,12_ 20/� <br />