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GUG-16-2017 06:29 From:DR Tom Bro 5075334101 To:17158664206 Pa9e:1,'1 <br />Fees (must aaompany rotor); <br />Burnett'County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br />survey of Existing Para): $50.00Aot <br />and/or Pre -Application Form Subdivision w/Survcr 5200.00+550.00/lot <br />Owner: 6reg A Aea,c.I Nomas rn <br />A <br />Address: o'4 �ZP a t1. Vv e i Zd Address: _c�Cl� V U i1e`i r� IZI, <br />w� S�Fsy � G� �r lrJl ,Sy�r93 <br />Phone: _ C2 1A - 20 - 03d Phone: �o7-S33-rp��5� <br />Orlainal Parcel Information <br />07 -02F-2 -y0 -1q -'T-5- oS,Ct0,7-013001 <br />Parcel ID o 0001 01:OOf Section��Township 1JC7 Range <br />O <br />.Original Description (or attach copy): 4-S. d *-3 C.s rA i 4 'Pa $ ;k G X Pri %of 3 <br />ro <br />kof Y C.5m u �i P 3,�6 4- PJ kat,3 <br />�s v 4 P�Bz ac_ 3714/ f6-ou ""- <br />Current Zoning: ?R 2 Floodplaln S' !: ►/ Wetland�Y V: �L.�� fiver Class: <br />Name of Water Body: U4% i61a�.A �P_ ShorelandAgreement/SIP-S <br />Farmland Preservation Y9 Managed Forestry Law Y <br />New Parcel Informatinn r <br />Proposed rNew Legal Description and Parcel Size: W <br />p e'd <br />Acres: <br />(if parcel is to besurveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: C <br />b <br />Proposed access to public waters to he provided YIN: A <br />If yes, describe access: <br />Signature of Owner: Date: <br />�i / <br />Signature of Owner: Date: O <br />9 <br />➢ Does parcel meet Zoning Requirements? Yes No <br />O <br />A <br />➢ Does parcel require a Survey? Yes No <br />e <br />�r <br />> Permit application fees submitted? ❑ Amount S Receipt k <br />�. <br />❑ Reconciles with Real Property Lister Yes No Date: <br />m <br />p <br />If not, explain: <br />e <br />Application: Approved / Denied Reason for Denial;--- <br />enial:-Land <br />LandUse- Date: <br />