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Far(mw accmgory form): <br /> Burnett County Subdivision Permit Application Subdivicwnw/osurvey: 1500 <br /> and/or Pre-A lieation Form Survey of Existing Pwoec Motslix <br /> PP Subdmx,nn w/Survey:120D.00+15.0011ot <br /> Owner. l(, Ir),k 1- ,, Royer. v <br /> Address: z'1 O L�-1ERR� ;TSN•-L•1`,Address: <br /> ic <br /> Phone. S Z Z-g Z- �3 O Z{" phone: <br /> Orieinal Parcel information <br /> 0-1-0% A 'x`51-16-2,9 S eS-eo3-otsooC <br /> Pareell": 'z6 Township 31 Range_ p <br /> Original Description(or attach ropy): e <br /> y Current Zoning: RR Floodplain Y/N:—Y—Wetlsuds YlN: N Lake/River Class: <br /> eName of Water Body: L{,Eee- Shoreland Agreement/SIPS Y/N, (l--1 r.— <br /> Farmland Preservation YlN: 1..6 Managed Forestry Law Y/N: NJ <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Sim: C`N\ '- L C i- <br /> 11� <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 /> m <br /> Proposed access to public waters to be provided VIN: "•. e <br /> G <br /> If yes,describe access: � <br /> Signature of Owner: Date: <br /> Signature of Owner. /""""""L J Date: <br /> 3 ( <br /> Y Does parcel meet Zoning Requirements? <br /> n <br /> Y Does pence!requirea Survey? Yes No a <br /> °O Y Permilapplicationfeessubmilted? X <br /> Amount$ r0 Receipt lr 'V <br /> o l) <br /> ❑Reconciles with Real Property Lister Yes No Date: UJ t <br /> e � <br /> If not,explain: <br /> � � N <br /> o <br /> Applicata Approved ! Died Reason for Denial: / V <br /> Land Use: Date: O 6 zo .f <br /> i <br /> pK �� vx - /s- II Q `'CE0VE <br /> OCT - 6 2015 <br /> BURNETT COUNTy <br /> ZONING <br />