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Fetus {must accompany form}: <br />Burnett County Subdivision Permit Application Subdivisionw/o Survey: S50.00 <br />and/or Fre-Application Form <br />Survey of Existing Parcel: S50.00/10tSubdivisionw/Survcv: 3200.00+350.00110t <br />�'atc�sor� FSE 3O° <br />Owner: k eA moi• k" /( Buyer: n <br />Address: 6y.3_�F_'_6AL4" Address: <br />Phone:jj"a(ol - fo©S7 Phone: <br />Original Parcel Information <br />6� oao ,t-Gln-i�-a7��s�3-otb000 �, <br />Parcel ID #: os --d_3- 013e�o i Section -7 Township qD Range /(n <br />O <br />Original Description (or attach copy): 404 rS1]0,20 L2 2 ����� 2Ef� <br />.rs.�`d hof ► csrn_41: 41/0Za_-�yloa-)a <br />Current zoning: 1 Floodplaite, <br />1Vetland �' l: Lake suer Class: <br />_ Name of Water Body; v ;s Shoreland AgreementlSIPY N: <br />Farmland Preservation Y Managed Forestry Law <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: <br />Acres: L/7 <br />(if parcel is to be surveyed, provide preliminary nrap. See attached rorpreliminary map requirements.) <br />Proposed access to public road: <br />Proposed access to public waters to be provided YIN: <br />i� <br />If yes, describe access: S� <br />_ Signature of Owner: Date: <br />Signature of Owner: Date:j'�" o <br />8-3174 <br />D Does parcel meet Zoning Requirements? Yes No <br />Does parcel require a Survey? Yes No <br />7 Permit application fees subm itled? . Amount $300 1 (ate Receipt N <br />❑ Reconciles with steal Property Lister Yes No Date: <br />If not, explain <br />ly L6 <br />AR 17 20 <br />Applicatio Approved f enied R son for Denial: <br />9,^ �� ,.�,�bd <br />2 � /'/ ' 7 'r F 7� )ietj BURNETT cni awl,. <br />Land <br />0 <br />(9`tGe Date:' <br />3/Z 710, -7 <br />ak <br />