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Burnett County Subdivision Permit Application <br /> and/or Pre-A lication Form or Ma Review Form h' s bsp,on <br /> PP P s. rP : r cssa omni <br /> 6hd.-s6n .tS _ S..nnno ts5noolln: <br /> Otmer: Tnm T3 cc-+sa � Ka.41+ru�Dn -r ISuper: <br /> Address. 5 u Address: - <br /> Phone: Phone: <br /> UJ <br /> Ori,,inal Parcel Information � <br /> Parccl IDN: Oi4 3 1 i Se 14 u n Section_'T ownship 3 S Ranged C <br /> c <br /> Original Desadption(or attach copv): �:)O . k U Um 6.v- 31 L 4 I `1 <br /> Current Zoning: R R 3 Floodplain Y/N: m P wetlands Y/N: N et Laka/Itiver Cl... I <br /> Name of Water Body: R'r . t,,k, Shoreland Agreement/SIPS Y/N; (�'I <br /> Farmland Pre,ercation \'/S: q Managed Forestry[,an Y/N: N <br /> Nett Parcel Information / p <br /> Proposed Sets Legal Da .L r. <br /> escription :.ad Parcel Size: 1,o l- Cans a4 <br /> Acres: i.I$ teres <br /> (If parcel is to be surveyed,provide preliminary map. Sec attached for preliminary map requirements.) <br /> Proposed access to public road: s 1,4 z <br /> Proposed access to public waters to be provided Y'1 <br /> If)'es,describe access: 0 g <br /> (I A <br /> Signature of lhvner: uP <br /> mgnamre of vsvncr: vote: a <br /> i Daes pnrrel meet Znuin�Reyoirem..a,' Yes Ao S <br /> G <br /> Oc sp rel )ifr <br /> f5 <br /> u, o.gJ l..d Y so R'o <br /> ?U v <br /> P rC: tp/I t- fmcniueJP � 1 : um S -5-0..DD Recrip: M j_ <br /> - <br /> P, <br /> ❑ Rut alar with Real Property Lister \es No Date <br /> If not,"plain <br /> Application: Appruced / Denied Reason for Denial: <br /> Land Use- [late: <br />