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Fees(must accompam form): <br /> Burnett County Subdivision Permit Application Subdivision,roSune,: S50.00 <br /> Suney of Existing Parcel: S50.001ot <br /> and/or Pre-Application Form Subdi'isionw Sure%: 5200.00-S50.0Ola <br /> Owner: ��it r+ z M _ Buffer: <br /> Address: J n e Address: 9 <br /> c=n ef, <br /> Phone: 7i5--&3_57- I'lleI Phone: _ d0 <br /> Orieinal Parcel Information <br /> Parcel IDM: Cr-0.2'5- Section Townshipt{(,?,(f Range tytc) <br /> Original Description(or attach copy): L-cv Ao f y EX _O'S 01 Ufa Pa5.3 f <br /> 0 <br /> c - Cx Csm vaa Pl)a i vw, of Sit+ a'4-'eff CL <br /> 1z Current Zoning: _Floodplain Y/N:�_W'etlands Y/N: Lake/River Class: <br /> -a � p� (� <br /> m Name of Water Body: Me-k Fy.2 i P /`c:.f5 L Shoreland Agreement/SIPS Y/N: 'rn� <br /> 0 <br /> .. Farmland Preservation Y/N: A/ Managed Forestry Law Y/N: <br /> New Parcel Information <br /> Proposed 'Sew Legal Description and Parcel Size: AJ at-) V <br /> Acres:_ •ti 3 <br /> (If parcel is to be surveyed.provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C <br /> m_ <br /> Proposed access to public waters to be provided 1'/N: <br /> If yes,describe access: <br /> Signature of Owner: Date: <br /> Signature of Owner:/ Date: n <br /> 0 <br /> a <br /> i Does parcel meet Zoning Requirements.' }•es., .\'o <br /> N 1 a <br /> Does parcel require a Sun et.' )es No <br /> O <br /> r Permit application fees submitted? amount S X67)' 0V Receipt <br /> clJ <br /> ❑ Reconciles with Real Prop",Lister Yes No Date: <br /> If not,explain: <br /> nure <br /> lv <br /> N Vi LL- ^ <br /> L <br /> Application-, pproved /,D'enied Reason for Denial: �— OCT 2 3 2015 <br /> �-_ ppro <br /> Land Use: < - / 20/ Date: ZONIN <br />