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Fca Imusr a:comoaM form) <br /> Burnett County Subdivision Permit Application Subdmsronw;osu c'% S5000 <br /> and/or Pre-A fication Form SuneyofEusrmgParcel S5000ga <br /> PP sum ision u/Sunc% S200.00-S50 O W <br /> �l Owner: I creerk Pe, ( Buyer: <br /> Address: 19y/ 5y/ i��S Roca Address: <br /> Z <br /> 2� <br /> Phone: Phone: <br /> — I <br /> Original Parcel Information 1 <br /> Parcel ID#: p 40 g <br /> D Z-d a(f a yU J tf S 0,S-ool p/6� Serction Townshi Rao e <br /> Original Description(or attach copy): PC- I //_Ou L07 t/ Lit- �J S <br /> f W.+ <br /> �.c- P_ caw "• <br /> > Current Zoning: Floodplain�: Wetlands 1 vet Class: <br /> Name of Water Bodv: P Shoreland AgreemeoVSIP 1/ <br /> Farmland Preservation 1'(C Managed Forestry Law 1't � <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> Acres•_ O .(a�p <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed aecess to public road: <br /> m <br /> Proposed access to public waters to be provided V/N: n <br /> If yes,describe access: L� <br /> Signature of Owner: r— _ / Date: <br /> Signature of Owner: Date: <br /> 0 <br /> 3 <br /> Does parcel meet Zoning Requirements' Yes NO <br /> n <br /> > Du--;-zrcel require a Survev? I'es No <br /> Oo - <br /> Q0 i Permit applicationftes submitted.' AmountO Receipt= <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> a If not,explain: <br /> ALA F <br /> n <br /> n <br /> 0 <br /> c <br /> " JU!L2 n16 <br /> Application A <br /> Pp pproved / nied Reason for Denial: BURN NTY <br /> Land L'se: :1 -� Dale: <br />