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teK lmun accompany ion,n: <br /> Burnett County Subdivision Permit Application Subdiv6ianwoSurvey' 550.00 <br /> and/or Pre-Application Form sar'veyarEisangpaal: ssa.aonot <br /> / + SurseyofFm i/icl,P : szoo.00+isa.omm, <br /> Owner: ee r1 -{,d-ds.,� � _ /��/!t �Bu cr: �i <br /> Address: o 07 /l lW1UWM Address: .23a6 60 IeD 4 3 <br /> Phone: /l-6- obq- 710 Phone: <br /> nformntion <br /> (' oo-oamo Yon/ /ybl/ <br /> PnrcelfD K:n��2 O�I' yd-I y-ll'I OI'O Section �� Towaship_Range_ <br /> q �y- O <br /> Original Description (or attach copy): 46T l ` ��) y - P,) �j / WAl `e <br /> Lor / L's�iy9 10,�o8> ly,:O ME- <br /> > <br /> Current Zoning: CJ 2 Floodplain YQ Wetlands Yo -l- <br /> Lake/River Classification: - Name of Water Body: <br /> Shoreland Agreemt or SIPS Ye-Farmland Preservation Y©':_Managed Forestry Law v. <br /> New Parcel Information q ' - - <br /> Proposed New Legal Description and Parcel Sim: Z L 07— (. ]� Ye Ol p-06 <br /> 19 P3i�-315 <br /> Acres: 317 <br /> (if parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> u <br /> Proposed access to public waters to be provided Y& A <br /> If vas,describe access: <br /> y�51gnatureof Owner: Date: <br /> t <br /> as / Signature of Owner: Date: e <br /> x� 3 <br /> D Doerparceln,eet Zoning Requirements? ' Yrs 'J No GK Tc' 1"e1y_e'L- n <br /> C > Doer parcel require a Survey? yet No <br /> Permit applicationfees submitted? Amounts3T.G(7 Receipts <br /> l <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> Application Approved Defiled Reason for Denial: <br /> Land Use: -r Date: <br /> TnTAI. P.nni <br />