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FSSobdm,i.. <br /> s[mus,ac"'Pany form): <br /> Burnett County Subdivision Permit Application dlvisw w/o Sar,z $50.00 <br /> �ey of Existing Pa c-& $5000/lot <br /> and/or Pre-Application) Form or Map Review Form .v Snr,e', S1o0.00I Ss0 oo/lot <br /> Owner: LMm ZI 10 o's^U e-C Buyer: 3 <br /> Address: % 01( Ko Lec 0 Address: <br /> S rICG'vl//,cW1' 5"�B zz� OI <br /> Phone: 7LS' `�`/ /,;,/6 Phone: <br /> Original Parcel Information <br /> 07-006-Z-s$-/7"2Z-/ Oq'00`1/ 000 Q -7 $ <br /> Parcel lD#: 07-006-g-38-/7-ZZ-y0/d00-o//Wcsection/Township 3S Range / <br /> Original Description(or attach copy): <br /> `J <br /> �J1 <br /> /J IL <br /> Current Zoning: h I Floodplain Y/N: Wetlands Y/N: Lake/River Class: <br /> b <br /> ,> Name of Water Body: U N N o w Shoreland Agreement/SIPS Y/N: /~ <br /> 9 q / <br /> m <br /> Farmland Preservation Y/N: /V Managed Forestry Law YIN: <br /> v t <br /> New Parcel Information 3 <br /> r <br /> Proposed New Legal Description and Parcel Size: iB'= Q7(AUN. Q /r^^lvto r tY <br /> IAA �o57Y1 V a5 <br /> Acres: <br /> 412 <br /> /or 8 <br /> (If parcel is to be surveyed,provide preliminary map�. 5'eettached for preliminary map requirements.) <br /> Proposed access to public road- 110 C/ C' <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> �- y/, <br /> Signature of Owner: �n 1�� ✓l'LCe�✓I-iQLJr) Date: /4.94—/4 3 . <br /> a <br /> Signature of Owner. Date:, <br /> ➢ Daespmcel meet Zoning Requirements/ Ye' Na v O <br /> CSm S b e/'r,D do � v <br /> �. ➢ <br /> Does parcel require a Surrey? Yes Wh yen tlDt <br /> a <br /> � Permit nppliealion fees submitted? ❑ AmauN$ I� Receipt <br /> ❑ Reconciles with Real Property Lister Yes No Date J 1 <br /> I v <br /> --� If not,explain: <br /> 6 <br /> A <br /> � O <br /> Applications Approved / Denied Reason for Denial: <br /> Land Use: „�-- Date <br /> 4715f <br /> /5f <br /> n q� <br /> O <br />