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Fees(must accompany form) <br /> Burnett County Subdivision Permit Application Sabdivwmo.oSmr cy: 55000 <br /> Smv. ,of F.Isong parcel: $So 00101 <br /> and/or Pre-Application Form Sabdmaioa.e/Some,: Szoaoo : S500o10 <br /> Owner: CAT14C17Lt Ns_ F Ttally Buyer: <br /> Address: 0�0yjt.=ST"0zlJ hJE +J. Ik444 Address: 3 <br /> $r 'PAVL MIJ (SSS icZ <br /> Phone: Phone: 6, 411 <br /> o -ti«Iz 4+- Sono Original Parcel Information <br /> . illz -Ll <br /> Parcel ID#:o.fil.li 4c 32.0 Section 'L'l' Township q-U Range 14 <br /> O <br /> Original Description(or attach copy): /AfYA4CH(4D <br /> c Curren %ening. RR I Floodplain Y/.N: n/ Wetlands Wnds\ w ✓ <br /> Lake/Niver Clnss: / (�S <br /> c y <br /> Nameof Water Body: MIODIG Allk-c4ZIE Shoreland Agreentenf/SIPS Y/N� I,t lcp <br /> `o T rn <br /> Farmland Preservation Y/N: If Alanaged Forestry Lou Y/N: A) / 1 <br /> New Parcel Information 05(11 V, aq. P. 33 +-336 (�A <br /> Proposed New Legal Description and Pa reel Size: eon 13,.+E TNRe E' I Cd Lor" Td .5 <br /> GRGArI= i"vJC Iscr L-0 rt <br /> Acres: $ r <br /> (If parcel is to he surveyed,provide preliminary roup. See attached for preliminary map requirements.) <br /> Proposed access to public road: Ro6.:2T lZ-1P O <br /> Proposed access to public waters In be provided Y/N: N q <br /> If yes,describe access: LcrS /.2 C- MIDo,G /Ne P—C—N}/E LMCE <br /> Signature of Owner. l Atc: <br /> Signature of Owner: Dat¢ __\ n <br /> 3 <br /> z <br /> CC c <br /> IJoes pnrccl meet Znniny Requiremerus9 Yes Na - <br /> L <br /> c i Ones parcel require a.Survry? Yes No <br /> ei Perrnir ayplicatimr/ers sahnilttedY Arnourtl$ Receipt# 1'`W <br /> laa <br /> + W <br /> ❑ Reconciles with Neal Property Lister Yes No Dole: <br /> n � g <br /> If nut.c,plain: <br /> � o� <br /> Application: roved/ Denied Reason for Denial: <br /> Land Use �%� Date: �� /� <br />