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Fust accompany fnm): <br /> Burnett County Subdivision Permit Application Subdiviees(msionw/o Survey: 55o.00 <br /> and/or Pre-A lication Form Survey ofE:osbMParcel: aso.00not <br /> lll� Subdivisioow/S,uvcv: S200.00+S50.00tlot <br /> Owner: [3('pIC2 i3ta01%C2 Q_aj% bt1 Buyer. <br /> ro <br /> Address: IOQ V4� Address: V 9 <br /> le� LVr fg-75 Qyo�1 <br /> Phone: Phone: <br /> Ori¢inal Parcel Information <br /> Parcel IDa: o7-Do8-2-38'/�-198-z C.-) QQ <br /> SectionTownship 3(, Range <br /> Original Description(or attach copy); E--A/,IV/ f <br /> A <br /> 5 <br /> Current Zoning: loodplain Y/N:�Wetlands Y/N: a Lake/River Class: one- <br /> Name <br /> e <br /> Name of Water Body: r D/l Shoreland Agreement/SIPS Y/N: alC <br /> - <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Information/ I <br /> Proposed New Legal Description and Parcel Size: �QP/Y S 6 u Csf►7 �j�y—�i <br /> Acres: <acres � <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 45 0 <br /> m <br /> Proposed access to public waters to be provided7: <br /> : Q A <br /> If yes,describe access: <br /> �7 GCi <br /> Signature of Owner: Date: <br /> Signature of Owner: Date: n <br /> 0 <br /> i3 <br /> y <br /> ➢ Does parcel meet Zoning Requirements? }' No a <br /> ➢ Does parcel require a Survey? es NO <br /> w <br /> ➢ Permit application fees submitted? Amount r / Receipt# <br /> m 13 Reconciles with Real Property Lister / \Yes No Date: <br /> 0 <br /> If not,explain: <br /> A <br /> n <br /> 0 <br /> Y <br /> a <br /> N <br /> Applicatio Approved Denied Reason for Denial: <br /> r <br /> P'l o O <br /> Land Use: Date; Z7 ZD <br />