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Burnett County Subdivision Permit Application SaU""Mvmisiioonw/ s <br /> ' eyy :$50.00 <br /> and/or Pre-Application Form s"'Ye'efExuu:nPtral. iw.00not <br /> Owner: TO JAZ-1 Buyer: <br /> f'0. Bay( 7`f6 <br /> Address: Address: <br /> Phone: 320- o?53—Q�y� Phone: (Ji <br /> q Original o —� <br /> Parcel m#: 0I/�'0AL -Z gU-35-3 03000/ �/ <br /> Township 7/A/ Range, <br /> Original Description(or attach copy): SGV <br /> VT <br /> O ,, <br /> Current Zoning: /` If <br /> 0 Floodplaln y<.1 ?W*`l" ,,// Ye j <br /> �WetlaadW <br /> Lake/River Classification: Name of Water Body: -- <br /> . New Parcel Information c75 <br /> Proposed New Legal Description and Parcel Size: 2 C SAI! S Cel J <br /> c 11 1 f <br /> _._�Olrn l �1A1 J ALI"C ` i-c.,Tl <br /> Acres: �. <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: rnl ?,I'VdL 14 f <br /> Proposed access to public waters to be provided V& <br /> n <br /> If yes,describe access: 00 <br /> �-1 <br /> Signature of Owner Date: gib) pp��� • <br /> 00 Signature of Owner Date: n d <br /> e <br /> 8 � <br /> > Does parcel meet Zoning Requirements? Yes No LC To '5N 0 <br /> > Doesparcel require a Survey? yes No r1 <br /> 6 O <br /> > Permit application fees submitted? Amounts Receipt# <br /> a L1 Reconciles with Real Pro ' <br /> party Lister Ya No Date: <br /> If not,explain: OI <br /> Application: Approved / Denied Reason for Denial: C7 <br /> Land Use: Date: <br />