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Burnett County Subdivision Permit Application s w, ,>a , g_n.5 unssaw <br /> le of Ednin Part:I: 5:0.001at <br /> Qnn,, <br /> and/or Pre-Application Form Svb/d�wvLan'nll5unx r/S'MM.S5000.1m <br /> owuer: L/N Q'11 > /s.yE.G'LV 742bna1 .as,�rr. a ILl 5165-7 <br /> if[ J�ZG/ i-•- _ <br /> Address: <br /> P, / 65&L A� A/ Address; o 65.77 5 // 6(n0�pp,4et` <br /> MN Phase GG�� Zd GCrrO .0 <br /> Tan.: ;5�)Yl s t, ,, ALP7/r 8(clu �lYy� <br /> 07-C24 -2-14k-/6-23-5 Original Parcel Information <br /> 05-ass-Uzymnp� , <br /> Parcel ID N: GY'UzD-Y-YO-/6-Z3-h 05-Mi Section L To,vnlhip YDN Range /GI✓ <br /> Original Description(Or attach copy): PCL Gell LUTJ l < r6 <br /> np � 1 <br /> Current Zoning: /C/.- Floodplain Y s'etlands 1'h� <br /> L.kc4tjver Classification: Name of Water Bady: <br /> Shareland Agreemt or SIPS Y6 Foradend Preservation Ye— <br /> hind Forestry Lan Y )_h <br /> New Parcel Information lh <br /> Proposed p'en Legal Description and Parcel Sire: _ G5/l� ,x5 <br /> Acres: -3 <br /> (If parcel is to be surveyed,provide preomimry ma ee vnahcC for preliminary map�re�q�ire/menb.) <br /> Proposed access to public road: -�Z`l - -W'�`J1 / tom /I�C��R— <br /> Proposed access to public waters to be provided YIN: 9 <br /> If ves,describe access: <br /> Signature ufo,mer. Lh�.�Gs'1 L1'lL!/ Date: <br /> Signaturco(O%vaer_ DotI 3 ZO� I n R1 <br /> o <br /> i Doerparrel meet Zaning RegW c,.enu° i'cs No -- _ <br /> Rl <br /> a <br /> > Dau parcel require a Sur q? y s No <br /> n <br /> 7 Pem,i,applimrion/ccs submirlel? Y\ Amount S . � Rnreipre <br /> 0 Reconciles with Real Property Liter )'es No Dote <br /> 0 <br /> — If ooL explain: _____. <br /> Appllroliom Approved l enied Raesan far Drulel: n014 Land Use- �= /7 zo/ Da,e: BUF VE�GUNry <br />