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Fees (must w mn <br />Burnett County Subdivision Permit Application I sabd;.�;on,�ros� $50.00 <br />and/or Pre -Application Form SurvoyorExisting ParceC sso.00not <br />pP , Subdivisionw/Server. $200.00+$50MIet <br />Owaa: /i. 'e"Iq€G --/w Bayer. o <br />Address: i5 z>1 &-/5(✓t . S, Address: <br />Phou. CP 11 455 <br />Phone: <br />Original Parcel Infonnatiou <br />Pared ID K: Z77 3.Q 2 /�- s' Z �38 Section Z 7 'Township Range /8 <br />O <br />Original Description (or attach copy): /.,n7 9 T /✓ Lo T <br />Cl <br />! J — <br />a•rent I.ORiRg:Floodplain1'lN <br />.�� Z :�_tYetlsnds YIN: ti LakclRiver Class: <br />Ntanc of Rater Body: ty u c Lri C Shortland Agreement/SIPS YIN; AJI <br />F. rmland Preservation YIN: N/;Managed Forestry Law YM: /V <br />New Pa.rel Information <br />Proposed New Legal Descript nd Parcel Sim-'} 4 2r/ A G <br />Acres: /. M& /jrC . <br />(If parcel is to be surveyed, provide prdimiaary map. See attached for preliminary map requireatents.) <br />Proposed access to public road: 7jr2 Jy�LN/a?/`t`SPKtra1� d <br />Proposed access to public waters to be provided Y/N:— Al R <br />If yes, describe access: <br />Signatureorowner. Dat. <br />Signature of Owner. ? t'y�`�s� Datr - 1�j 1-7 <br />o <br />m <br />Y Does parcel meet Zoning Requirements? Yes No n <br />Y Does parcel require a Survey? Yes No u <br />A Permit application fressubmated? Amouru s—LELw Receipt # <br />Q Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />Appli Approved / led Reason for Denial: —� <br />Land Use: <br />ECENE <br />FEB 27 2017 <br />BURNETI'COUNTY <br />ZONING <br />