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Fees (must accompany toren): <br />orm): <br />Burnett County Subdivision Permit Application Subdivision w/o Survey: S50.(M) <br />Sta-vey of Vxisfing Parcel: S50.0011ol <br />and/or Pre -Application Form Subdivision w! Survev: S2(M).00 t SSOMO/lot <br />Owner: M4gA:AZ�T J�"�N Buver: <br />Address: I ? V1 & FCAA LVrj',-R 'T'?ZA, L, Address: <br />Phone t, 4, 24 <br />Original Parcel Information <br />:.J. <br />Parcel ID #: f -j *C, Section Township 3jr Range <br />Original Description (or attach copy): i <br />Cut -rent Zoning: i,W-i Floodplain YIN:_Wetlands YIN: t4 Lake/River Class:— 91 <br />Naincof Water Body: wtwc> L. A�--. —ShorelandAgreement/SIPSWN: t4 <br />Farmland Preservation YIN: kj —Managed Forestry Law YIN: N <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: t.ew 1, L �=-1 - '744L <br />Acres: <br />(if parcel is to he surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: *41, (� ,,-i ­ V! - <br />Proposed access to public waters to he provided Y/N: i,,i <br />If yes, describe access: <br />Signature of Owner:Date: (0 4/2 <br />Signature of Owner. <br />No <br />)'es No <br />Rcceipt 11 <br />0 Reconciles with Real Property Lister ves, No Date <br />If not, explain:--, <br />Applicatio Approved enied Ream.m for Denial: r_"'t r= i --N r= nn n r= <br />Land � 9/19/Z-0/7Date: <br />Bl RNETT MAW <br />ZONING <br />W, <br />ot <br />n <br />-it <br />