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Fea(must accompony form): <br /> Burnett County Subdivision Permit Application SaW..isfaawtasar,ey: $30.00 <br /> and/or Pre-Application Form Suey oMdvinc Pored: $30.00gm <br /> PP // a Suhrvdivlsion w/Survevi $200.00+$50.00/1ot <br /> Owner: J_e F6rey LASS R/-I Buyer: <br /> Address: P!/ VOX 66- Address: <br /> weer— d, 1Vj sy3Y3 0 <br /> C> 3 q - 3(, 3 - 3-7 <br /> Phone. �lfiftt 7/y-/3Y-09�/ Phone: <br /> it <br /> Ori incl Parcel Information <br /> G <br /> Parcel -UroSectio Township ageY <br /> Original Description (or attach copy): _Jt A/E Qrl/d 4,1 2r <br /> Cur.-:,I Zoning: Floadplain&)N: Wetland&NI : <br /> Lake/River Classification: -3 Name of Water Body: �Nr/GXC <br /> New Parcel Information n <br /> Proposed New Legal Description and Parcel Size: I Lot / ANf, <br /> 6 ur-LOT / e!!5 12-i \ ,a5 �q-ri7) -- <br /> Acres: <br /> (If parcel is to be surveyed,provide <br /> /p,,re�liiminnry map. See attached for preliminary map requirements.) <br /> Proposed access to public road: / 21 r/ G IG Lzl_lZe. Rea p <br /> v <br /> Propose)access to public waters to be provided Y� _ <br /> If yes, describe access: - <br /> c Signature of Owner: Date• <br /> Signature of Owner: Date_ c <br /> a <br /> _ 9 1 <br /> ➢ Does parte!meet Zoning Requirements? C_ Yesy No � r (J I <br /> T� a➢ Does parcel require a Survey? Yes No <br /> n <br /> 7 Perntitapplicationfeesru6mitted? ❑ Amount$ Receipt <br /> 0 1 t <br /> v <br /> ❑ Reconciles with Real Property Lister Yes No Date: lVUJ <br /> If not,explain: <br /> Application: Approved Denie eason for Denial:_ Oof/el- T ha cbr,la./ %o 61k."f-t� <br /> Land Use: Date: I"fes"�Y <br />