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Fees(must accompany formq:
<br /> Burnett County Subdivision Permit Application subdivi.on w/o Survey: S50 00
<br /> Survey of Existing Parcel: S50 0011ot
<br /> and/or Pre-Application Form 4 SubMvisian w/Survey: C200.00 S50.00/lor
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<br /> ' Owner: Pa-444S cas,44 44:Lc:I5,--p-,.Aft Uwer: \Tc c7 e.,r-It fi-- ,,1
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<br /> Address: Lit /16f-612441.442-(--- go VP Address: 27,lc:,4 L 6:•-•:,tok.31-11 1410 IA 5
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<br /> iitil,:i.- Lt I iiiii44e) c;KAAJT);11.1.ge„ 1.441
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<br /> Phone: 415-4-9 1- I 44- Phone: 05
<br /> Original Parcel Information 0
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<br /> Parcel ID#: ci,,,e,,q102-2,4,44..At i,p;.z d)4.44._vi-.01 3.4_,I Section geid fc Township 3 Range Le
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<br /> Original Description(or attach copy): Yi.:'-i.::. 4rRICI-0.-i0 =
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<br /> t` (\v ONS) 4-1-,....,k--2-c)I;)47.11%.s.-X\Nts 'o 'r \epoo-C1 .4
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<br /> cz As, " .\\,:a. q5c.).-s-ve\-\ 4.• =1.1 +-. . G.:1-7„c. , 5--'\,. , C),,S, R
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<br /> ,•,"; Current 7Aming; Floodplain 1//N: 14 Wetlands Y/N: Lake/River Class:
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<br /> fa Name of Water Body: Shoreland Agreement/SIPS YIN; Ni 4
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<br /> Farmland Preservation ViN: ,,,,I Managed Forestry Law l'/N: Ni
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<br /> New PiteCel information
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<br /> Proposed New Legal Description and Parcel Size: 1-4,T i ivevu Of-4
<br /> Acres: 'k 2-4
<br /> v (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map retittirements,)
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<br /> Proposed access to public road: cot.40,47, Av.44) t1/4% ci
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<br /> Proposed access to public waters to be provided Y/N: xi r
<br /> - 3\s.
<br /> If yes,describe access:
<br /> Signature of Ow-L-mIckner: -if-41 'ir i A "'ate: 5.....5-- - 26 ,2-6
<br /> Signature of'Owner,la
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<br /> 4 Date:
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<br /> "...- Does parcel meet Zoning Requirements? Yes No at.
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<br /> Does parcel frequoe a Surrey? Yes No
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<br /> - NO C1.1
<br /> 0- Permit application fees sztbmitted? 0 Amount$ Receipt# 6.`
<br /> _ .)•) 01
<br /> t- 0 Reconciles with Real Property Lister Yes No Date: 14)•••0
<br /> AA 01
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<br /> la. If not,esplain:
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<br /> Application Appro -"-
<br /> ved / ted Reason for Denial:
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<br /> Land Use: ,c//V?,i f 2 Date:
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