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Fees(mart auomaanY form): <br /> Burnett County Subdivision Permit Application sebai.isionoloSm ey: S50.00 <br /> San,of Esis ng Pasl: $50.00001 <br /> and/or Pre-Application Form <br /> 7 5200.00+s50.009m <br /> Owner: LEni LPI D10 Buyer: <br /> S <br /> Address: �ylY, 0,,J6 ,,, LI�,rVC-_ Address: 3 <br /> ecu nUf'lt�� L [0113 <br /> Phone: OU 7 - 1 - UU V7 Phone: <br /> Original Parcel Information <br /> /7 <br /> Parcel ID 0; UO(v -2$ 7-Q3coo £ C)3/Section -7 Township 3� Range O <br /> Original Description (or attach copy): <br /> \ <br /> SEC- I �C'E fl ' )OC. NU / L <br /> y <0 <br /> o <br /> Current Zoning: fzI Floodplain Y/N: N Wetlands Y/N: /I <br /> Lake/River Classification: Name of Water Body: Mt-D /Je j L Ali b' <br /> n <br /> Shorelantl Agreemt or SIPS Y.pV: Farmland Preservation Y/K.) Managed Forestry LaeY N ) <br /> New Parcel IInforrm^ation V"I5 1_ <br /> Proposed New Legal Description and Parcel Size: DA ( F , (7 <br /> PA(2CCL iNTzp )tvo LOTS <br /> Acres: U'y/ <br /> (If parcel is to be surveyed,provide preliminary map. See attached for ppreliminary map acquirements.) <br /> Proposed access to public road: I—('eNT/;( F oz-.) y'ti t�Ul- 2U/\ ✓JS e <br /> Proposed access to public waters to be provided YIN: t'�O <br /> If ves,describe access: <br /> c Signature of Owner: N Dale: <br /> 0 <br /> 0o Signature of Owner: Date: r] <br /> c <br /> e <br /> Does parcel meet Zoning Requirements? Yet No (j — <br /> s ➢ Does parcel require a Survey? Yes No x <br /> Permit applicationjees submined? AmwmtS JaU-e-y ReceiptH <br /> 'o <br /> a ❑ Reconciles with Real Property Lister Yes No Date: 'C <br /> � J <br /> If not,explain: ry <br /> I I <br /> Appli tion: Appros'ed-rbenied Reason for Denial: <br /> Land Use: Date: <br />