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Fos(must xcwnpeny form): <br /> Burnett County Subdivision Permit Application auhdw.iaxeccon cy: sso.00 <br /> Swvcy of Existing ParcelS50.001ot <br /> and/ort Pre-Application Form n - Suhdieision.a Sw,ev: Sz0ft W 4550 Wfid <br /> x 1 <br /> Owner: htAfC PI`4001- 6 Buyer: .o <br /> Address: IGt 14Tp ASE .C - Address: V�tAC1 <br /> lirFN"J� - PA J . 17 �3N3 � 1 - `3913 <br /> Phone: 61-Z 7D - _,675 Phone. z C� <br /> Original Parcel Information <br /> ParcellDq: 61-0-2G-7 Section R_Z"rownshiejq Ktj�:;iiangc 1LW C <br /> 01- O <br /> Ori mal Description nr Rach copy)IlOG6: � <br /> A7-ttttun CoN <br /> > Current Zoning: V2 Floodplain Y/N:�Wetlandx Y/N: Lake/River Class: <br /> 'a <br /> Name of <br /> N'ater Radix: IJO0- \E\ Shorebird Agreement/SIPS YIN, tJ <br /> Farmland Prexenation YIN: Iv Managed Forestry Law YIN: ( ``y <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> �TThe llfr> CaP•/ <br /> Acres: I <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> P <br /> Proposed access to public road: <br /> • m I <br /> Proposed access to public waters to be provided YIN: _ n <br /> Q% <br /> If yes,describe access: CU <br /> Signature0l Owner: % Date: �4/6 <br /> W <br /> 1 <br /> _ Signature otow ner. )air: n <br /> e <br /> Does parcel meer Zoning Repatremems.' Ye No 111.1 <br /> Does parcel reymre a Su rv? Y,, hh t <br /> wsu <br /> D Permit application feee sa6m(ued7 � Amanm$ 0G Receipt M I <br /> ❑ Reconciles with Real Property Lister Yes No Dater ZUl� <br /> Bum,explain: — <br /> F <br /> 6 <br /> Application: Approved Denied Reason for Denial: <br /> Lead use: Date: FEB 11 2013 <br /> BURNETTCOUNTY <br /> ZONING <br />