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Fecs(must aecompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/oSurveK Sso. o <br /> Survey of Existing Parcel-$SU.U07 of <br /> (� and/or Pre-Application Form Subdivision wlSurvev: 5200.00+S50.0011ot <br /> Owner: ro_,\+ , en_ze it, y� Buyer: /� <br /> Address: 2- �PIP/p 60Yes )a„d/YlQ a-Address: S0 R/ilep, )Poa 4, ? <br /> �rot/t ,/ ,{�Wr 5zlxhlo �G(I�SDn; LUZ 51/01(0 <br /> Phone: ��� '7`�3' /��� Phone: J ' �.QI .�/e d <br /> Oriainal Parcel Information <br /> Parcel ID#: /Section 0 Township / Range <br /> � <br /> Original Description(or attach copy): O /._/__q o s m VO ' 19 O O <br /> q Current Zoning:�° _ Floodplain Y6. Wetlands YAN:I <br /> / Lake/River Class: <br /> C lJ IIIJJJ�� <br /> Name of Water Body: v A Shoreland Agreement/SIPS <br /> Farmland Preservation Y Managed Forestry Law Y <br /> New Parcel Information /a 11 / (� <br /> Proposed New Legal Description and Parcel Size: /01 f ! CSmy''t?! O` <br /> 36 <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: PAR(e) A P,S _row,, �� -Fro -CL Q C <br /> r <br /> Proposed access to public waters to be provided Y� <br /> �O <br /> If yes,describe access: rj/ Pr <br /> Signature of Owner: Data .� <br /> Signature of(Tuner: Date: <br /> e <br /> 9 <br /> ➢ Does parcel meet Zoning Requirements? l Yes i No <br /> D Does parcel require a Survey? Yes No a o <br /> Permit application fees submitted? ❑ Amount S Receipt# o Q <br /> Cl4 <br /> �. <br /> ,1. Reconciles with Real Property Lister es No Date: <br /> If uot,explain: <br /> � o � <br /> 6 <br /> Applicata : Approved Denied Reason for Denial: <br /> OCT o <br /> Land Use: e. <br /> ZONING c' <br />