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Fees (must accompany form): <br />Burnett Counter Subdivision Permit Application SubdivisionwioSurvey: sIW+S50-00/10 <br />Survey of EsL� Pared <br />and/or Pre -Application Form Subdivision w/ Survev: 5200 <br />Owner: JAhSGoyt.i'ire Pr2e`¢2fT1-2jr <br />Address: M A 9 11,em e &j ariy a,3 ` -tz ote< <br />1-74T jea 04* 19M V-< <br />fra-], FL X2239 <br />Phone: <br />Buyer: Jed{ T Lau;Je tTctl/UJ <br />Address: �y��le )V—Q d <br />M1=ekP,j1z, Ihm. -5132r <br />Phone; qf2. go? s 1920 <br />f <br />1103') Original Parcel information D �G?4�eo cop <br />Parcel ID #?40-M- a- S" 15-4M-03g&oo Sectionl*A"O_Townshi *O Range 1 <br />Original Description (or attach copy): _ Loi <br />j ,/( <br />Current Zoning: ' ` t Floodplait : Wetlands Y N a{ ver Class:_1_ <br />Name of Water Body t1 I'dot i� � &-kf It 2;.e Shoreland Agreement/SIPS Y& <br />Farmland Preservation YAW Managed Forestry Law <br />Nm Parcel Information <br />Proposed New Legal Description and Parcel Size: / 1--t CS th <br />Acres: -0. 4 4 <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: Ile f <br />Proposed access to public waters to be provided YV <br />ff yes, describe access: <br />v' <br />r Signature of Owner: u ' Date:IL <br />Signature of Owner: mate; <br />Does parcel meet Zoning Requirements? Yes No Z ) l 7 <br />➢ Does parcel require a Survey? Yes No <br />o� <br />Q0 > Permit application fees submitted? ❑ Amount $ # <br />r, Cl Reconciles witlk RAW Property Lister Yes No, Bate_ <br />m <br />°• If not, explain: <br />0 <br />rA <br />a <br />Applicatio Approved Denied Reason for Denial: <br />Land Use �3 ZOO Date: <br />M <br />n <br />i <br />O <br />m <br />H <br />0 <br />P <br />