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.Sur � '. <br /> ree�(mast aewmaa�y r�/. <br /> Burnett County Subdivision Permit Application semi sioawmsa y: ssoon <br /> Sunry of Existing Parcel: 550 OOnot <br /> and/or Pre-Application Form sanai.i�i„a((w/sm.e�: szoo oo+aso oamt <br /> Owner: c,,mP¢ C_ /n 11 Buyer: -.r, <br /> Address: 30ti A4V/,9P.) 6?W/LAddress: 3 <br /> AMh2/LLO , /X 79/CD$ e <br /> Phone: 806 E751- &5-9- Phone: 7/ 997'-OR 70 <br /> Original Parcel Information <br /> O/ /000 <br /> Farrel lD q: 0?'DUB-2-38-11//$-$ OS-O66' Section Township .36 Range <br /> O <br /> Original Description(or attach copy): 5CC Vol 2-309R I1 3�7M�� <br /> Ex`s>Sna /of Since I l� 3� IgbB - ''' t — <br /> f <br /> a Current Zoning: 02-I- Floodplain Y/N:�_Wctlnnds Y/N: 1'10 Lake/River Class: N <br /> 9 Al^ Name of Water Body: 3os hc,W 7,c /« Shoreland Agreement/SIPS YIN- N p <br /> O <br /> Farmland Preservation Y/N: A Managed Forestry Law V/N: 1s/O <br /> New Parcel Information '�3 - <br /> Proposed New Legal Description and Parcel Size: LOT /, �.5 M '� --�- VO/ � - <br /> 0-419 ',K <br /> �43101 !- <br /> O ! %1 9 t,K 30 1 _- Acres: <br /> V <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: yes , et ri <br /> Proposed access to public waters to he pro/v�ided Y/N: fCf 'per' <br /> If yes,describe access: 77f/'d/1 q rI d <br /> Signature of Owner: - _- { T. --ILN=-- -- - -Date:ti- -d.d Z <br /> Signature of Owner:'/ Date: f1 <br /> 3 <br /> ➢ Does parcel meet Zoning Requirements? Y _ No <br /> N a <br /> � ➢ Dces parcel require a Survey? Yes � Na <br /> o � <br /> as D Permit applicationjees,submitted? Amount$ ��elJ l� Receipt): <br /> r. D Reconciles with Real Property Lister Ves No Date: <br /> I <br /> If .Q[ <br /> Q) <br /> Apphcatio .-.Approved / Denied Reason for Denial: SJ <br /> I <br /> Lord Use:- D t 9 Z Zo/y <br />