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Feu (must accompany form): <br />Burnett County Subdivision Permit Application Subdivision Wo Survey 550.00 <br />SurveyorE.cisting Parcel SSOM!lol <br />and/or Pre -Application Form Subdivision W Survev: S200.00+$30 Mlot <br />Owner: :s�avhps e&aii Ka -Ig g *fel Buyer: <br />Carr; P 54; IP_s les (— <br />Address: ffk e ff.! Lam e- Address: 3/3/ i _kPf(V <br />Phone: Phone: &5 l ' 2t/ <br />OrldnaI Parcel Information <br />o7-038-.?-q1-/q-,74-V 03-ew'.O1h0,90 <br />Parcel ID #: o.S �p,�-17ppp Section /Township 'j ( /Range <br />J <br />Original Description (or attach copy): k) S n A Ar I t' n 6"6-0. /_c) t <br />Current Zoning: rLr M Floodplain\: Wcliands ill: Lake! iver Class: <br />Name of Water Body: �� !Yt n � hPc 1 ,s1+cF Shoretand Agreement/SIPS l N <br />Farmland Preservation Y(i:) Managed Forestry Law <br />Ngw Parcel Information <br />Proposed New Legal Description and Parcel Size: Ale t:_rJ 2 J.D i C S Yy1 <br />1�coCA )6+-, <br />Acres: <br />(if parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: <br />Proposed access to public waters to be provided Y/N: <br />If yes, describe access: <br />CK <br />a <br />Signature of Owner: L <br />: <br />Date: <br />Signature of Owner:-r�.(#i�'� <br />Dater <br />> Does parcel meet Zoning Requtrernents? Yes <br />No <br />`r Does parcel require a Survey? Yes <br />No <br />Q° <br />r Permit a licatiorr ees submitted? ❑ Amount S <br />Pp f <br />1 04 . <br />Receipt it <br />�. <br />D Reconciles with Real Property Lister Yes No <br />Date: <br />a <br />If not, explain: <br />0 <br />G <br />b <br />.. <br />Applicatio . Approved Denied Reason for Denial: <br />Land Use: _ /y/? ZZ <br />Date: <br />CK <br />a <br />