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Pecs(mus,accompany farm): <br /> Burnett County Subdivision Permit Application SnSdtvtoonwdosnrvcy: S5000 <br /> Survey of Existing Parcel 550.00/109 <br /> and/or Pre-Application Form Subdivision wr Sonvev: S300.00+ $50 ONIot <br /> I Owner: AOfJ 0L2,41G11/ Buyer: 7 <br /> AddressGIe LLE NVj Address: 3 <br /> i <br /> SLK R.9Va , 07N 5-5330 <br /> Phone: �P iZ ' tG f Phone: <br /> C <br /> Orieinal Parcel Information � <br /> ParreilDq: Section 3 Tow nshipt 39 Range1U tJ W <br /> O <br /> Original Description(or attach copy): A17-KIrGD <br /> .o Current Zoning: Floodplain Y/N: Wetlands V/N: Lake/River Class: <br /> ^ Name of Water Budy: aGVII S LSTYE Shortland Agreement/SIP51'N: <br /> 0 <br /> Farmland Preservation YN: Managed Forestry Law YIN: <br /> 1 <br /> New Parcel Information <br /> J <br /> Proposed New Legal Description and Parcel Size: TNK IS N1 �1TT)NG YNtc€L <br /> ft-,rn V P <br /> i <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. Sec attached for preliminary map requirements.) <br /> Proposed access to public road: p <br /> Proposed access to public waters to be provided YIN: <br /> O <br /> If yes,describe access: <br /> Signature of Owner: A/ _ Date: <br /> Signature of Owner: Date: e <br /> 3 <br /> 9 <br /> i Does parcel meet Zaning Requirements? Yes Na <br /> Daesparcelrequirea Sane,? )'es Noan O <br /> J <br /> r Pennil appllcarimi fees submOled7 [� Amounts —5D•CT Receipt N <br /> r. R ElRrconciles with Real4roperty Lister Yes No Date: Q <br /> n <br /> e If not,explain: W <br /> z <br /> 9 <br /> Application Approved / Denied Reason for Denial: r�•�� <br /> / I <br /> Land Use: Date: <br />