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Fees(must euompany form): <br /> Burnett County Subdivision Permit Application Sunaivisionw/oSurKy: SSo.oa <br /> Survey of Esisting PuM: fso.00not <br /> and/or Pre-Application Form Suhdivisinn w/Survey: 5200.00+530.00/lot <br /> S=a <br /> 1.1 Fi(nr,,r /� <br /> Owner: LINn/+ �(Gv1BS„wl Buyer: <br /> Address: 239ot CRA.Vr"'. A11PJ't19P Address: 3 <br /> W< i'I-c S-4Y9? z <br /> 0 <br /> Phone: 349' 2C9y Phone: <br /> Original Parcel Information O <br /> piicoi <br /> ParcelIDN: D -1 '-014-2-3°-lr-1S'S 05-0AS' Section Township �� Range Ir O <br /> p F <br /> Original Description (or attach copy): PGrI or Cc�a G Al or Cpapl.�ty ALf/bJ%/I� <br /> m <br /> Current Zoning: R Z Floodplain'/N: Wetlands Y/N! L1711, <br /> PC. <br /> �1 <br /> Lake/River Classification: Name of Water Body: P 11,Va Ph <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: G.1'm 3 Lo T 1 <br /> CklJ'li< 6 Jr( i i <br /> Acres' <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: YeJ <br /> O <br /> Proposed access to public waters to be provided'Y/N: W4 , <br /> Ifyes, describe access: <br /> 6 <br /> c Signature of Owner: Date:.( <br /> 0 <br /> Signature of Owner: Date: c <br /> 0 <br /> i Does parcel meet Zoning Requirements? Yes No Q(G YZ 7SC/- <br /> /7.1l.-1� a <br /> i Does parte(require a Survey? Yes No - <br /> 6 <br /> � i J <br /> 7 Permit application fees submitted? Amount S=3-9),()7) Receipt# g <br /> o <br /> n <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> lu <br /> If not,explain: <br /> O <br /> I <br /> I <br /> Applicati n: Approved)/ Denied Reason for Denial: ry <br /> �1 <br /> I <br /> Land Ussee/ Date: 1,)-/e1"C3 <br /> v <br />