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Fccs(mus ac-mnpany foam): <br /> Burnett County Subdivision Permit/Survey Review Sub ivision w/o Survey: $50.00 <br /> Suney of llxkfing Porccl: S50101of <br /> Application and/or Pre-Application Form susjoislon%/sur.ev: S200JX)+$5000Aot <br /> Owner: C-e_kk-a C�T KQ 1; Ruyer: <br /> Address: RJ Address: <br /> y/IG',, G(/ 3_ <br /> Phone: /l S- r2/o(� - /0al'2 Phone: <br /> f 69-Oa0-a-�IO-1ln-GS-I -03 _ Original Parcel Information n <br /> ©6d- 0/(000 <br /> ParcellD#: Oao- 44315- 6I - 3ao Scction_J5 Township /'/a Ranget(�2 <br /> Original Description(or attach copy): LI) )/ I L/ SCC 15, 702- IN U <br /> i <br /> Current Zoning: / ' -d` Floodplain m. Welland 6 Y/N: Lake/River Class: /V <br /> o <br /> Name or Water finds: N Shoreland Agreemcn PS Y�J:� <br /> o <br /> Farmland Preservation Y Managed Forestry Law /N <br /> o <br /> New Parcel I//7 MI/ormation Q ) <br /> Proposed New Legal Description and Parcel size:wa / EWA/ f" y <br /> Acre,: �D <br /> (If parcel is to be surveyed,provide preliminary map.^See <br /> �attached for preliminary map requirements.) <br /> Proposed access to public road: LOIR-e/ <br /> Proposed access to public waters to he provided Y61 •'• <br /> (ryes,describe access: /U A- <br /> Signature of Owner: k;Alfi/F L✓ lr Datei/v 3 113 <br /> Signature of Owner: Date: e <br /> 0 <br /> 5 <br /> S <br /> Docs parcel meet Zoning Requirnnerzzr? Yeo No r, <br /> N R <br /> o : Ones pnre'r(require u Sumey.' Yes No � <br /> n ^ O <br /> i Permit npplicn(ion feev subrninr<f? � Ammml$ � �— Recripr# <br /> 0 Reconciles with Real Properly Lister Yes No Date: <br /> m W <br /> n <br /> z If not.explain: v ' <br /> 0 <br /> Q <br /> Applicalio - Approved Denied Reason for Denial: <br /> Land Use: Dale: <br />