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Fens(must accompanyform): <br /> Burnett County Subdivision Permit Application Suhdivisionw/oSumcy: 550.00 <br /> Survey of Existing Pared: $50.00not <br /> and/or Pre-Application Form Subdivision wf Sarwev: 11200.00.s50.00nm <br /> Owner: — Buyer: ,e <br /> Address: /L'YrJZ /r /V ;'lyAddress: 3 <br /> &r Low, h _6W-M <br /> G) <br /> Phone: �LD�(O»"- d—D Phone: <br /> Ori`-inal Parcel Information / / <br /> Parcel to N: U7�G��'a�- y/��lj '�p J 6' 71 S"fion o Township Ikl Range //O 4/ O <br /> Original Description(or attach copy): �bc_p"„LI ✓l iji D71i Ar/// zy SPL ag� <br /> 7- <br /> 3� <br /> a <br /> '— Current Zoning: 'Cel Floodplain Yl I Wetlands o <br /> Lake/River Classification: Name of Water Body: "— 7Z <br /> New Parcel Information � <br /> Proposed New Legal Description and Parcel Size: 2 Lo T <br /> Acres: �-CJ <br /> (If parcel is to be surveyed,provide preliminary map. <br /> See attached for preliminary map requirements.) <br /> 7 <br /> Proposed access to public road: 5. i • <br /> O <br /> Proposed access to public waters to be provided <br /> If yes, describe access: <br /> ii Signature of Owner: Date: <br /> 0 <br /> 0° Signature of Owner: Date: r) <br /> o I <br /> 3 <br /> a <br /> Does parcel meet Zoning Requirements? Yes No OK v" 6+3�r3 n <br /> D Does parcel require a Survey? X '—Yerl No lt <br /> Permi(applicorionjees submitted? / , gmounlS g/V• V(/ Receipt 9J <br /> o <br /> a ❑ Reconciles with Real Property Lister Yes No Date: p� <br /> If not,explain: <br /> Applicati Approved Denied Reason for Denial: <br /> Land Use: _ ,ll Date: �� L� <br />