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moat mccm <br /> Burnett County Subdivision Permit Application snFetalxfi(via#on w/'oa s,pa�nyy:farm Ss}:o oo <br /> and/or Pre=A lication Form Swver of Exi:dag Paul' s50.001lot <br /> Pp SUuVisim Wi Sian: s200.00+sso.00n« <br /> n ��✓cvt <br /> Own": t� >�,. _ S _-TT <br /> ! --, <br /> Address: -71-S- E . /,,'1A'R t 0 L_A Cr. Address: 7g>,i.,a..o.2 L41rA r r a}% <br /> n A ,�lli0/la <br /> fit. <br /> Phone: Q - - y Phone: �1 nz Z. 'zl'2 - I t � G <br /> CA <br /> Original Patcel hiffmation <br /> Pared ID#: b T �ti8-Z- `! - tce _ ,,,. 1 ° ^� Sectlon_!�P__Townsh1P S 9 Rauge__L!�? <br /> Original Description(or attack copy):-- -o'i'_ 11,-ei <br /> Ca -c't - Z'-3q -try-O t3_C.AA&: <br /> O I k cx�p <br /> Current Zoning: Floodplain Y/N: Wetlands YIN: T LakelRiver Class: cA <br /> Name of Water Body: ell® h+ ei Shoreland AgreemeattSIPSY/N• <br /> PO <br /> Farmland Preservation YIN.---A-) Managed Forestry Law YIN: <br /> fi <br /> ew Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> r ��:��Yc,r►�e�y /�GNpy <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C as:±: f t •-�" n 2C j <br /> Proposed access to public waters to be provided Y/N:� �- <br /> If yes,describe access: �x� �--i 1�+.�,._. 4tc.es5 � i t!?��� t`��•l cam'- fi <br /> Signature of Owner: Date: <br /> Signature of Owner:_ AA Dater <br /> �? E3 <br /> A Does parcel meet.Zoning Requirements? Yes No <br /> ➢ Does parcel require a Survey? Yes No <br /> ➢ FerMit application fees submitted? ® Amount$ a? <br /> > �r# <br /> ❑Reconciles with Real Property Lister Yes No pate: <br /> If not,explain: <br /> Application: A Pproved / Dealed Reason for Denial: <br /> Land Use• Z•t'o / Date- <br /> IE /�::�D E 9 V IE <br /> J�J� 2 5 2�1y <br /> Burnett County <br /> Land Services Department <br />