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Tens(must acc V(I <br /> Burnett County Subdivision Permit Application 5ubd1v1s1onm'M="Vc1745;0 g <br /> Survey of Exizimg Pxcd, 5 at <br /> and/or Pre-Application Form Subdonsion A!Survcv: $200 00+$50 00;lot <br /> Owner: ?„50Z 5. d Buyer: <br /> Address. L <br /> 2'V 5-5 i S5 i Oe J4dd:5rcss: <br /> rA ki .S5_ Q�l <br /> Phone: Phone: <br /> Original Parcel Information <br /> " o 9-0 1 AC4)�) <br /> 5--L-) <br /> Parcel ID 4: Section 7 Township qO Range <br /> Oei.nal �011 <br /> _�, Description(or attach copy)-. RA Ael �Jzli I <br /> a L-6 v P& i :s "Ir IR 5ek I Swede <br /> 3 C t!rA v .3 Ptrc 6-,o 4oPC JFol 3a <br /> > Current Zoning: <br /> I_Flotidplain(YN. WettandsY/-N: )L)—LakclRiver Class: AJE_ <br /> Name of Water Body: N C'VV\' k�k 2 Shortland Agreement/SIPS Y/N.-_ <br /> Farmland Preservation Y/N: —Managed Forestry Law YN: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size- '.0 L1.) Q2 /0 <br /> Acres: 3. <br /> (if parcel is to be surveyed,provide preliminary map- See attached for preliminary map requirements.) <br /> Proposed access to public read- <br /> Proposed access to public waters to be provided YIN <br /> If yes,describe access, <br /> Signature of ONvner: Date, <br /> Signature of Owner: Date; <br /> Does parcel meet Zoning Requirements No <br /> 0 Does parcel require a Sunv,v? es NO <br /> Permit application fees submitlear' Amount S Receipt <br /> 0 Reconciles vvith Real Property Lister Yes No <br /> If not.explain: <br /> Application: Approved I nied Reason for <br /> Lanai Use. Date: <br />