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Feb. 9. 2016 8:03PIN Staybrid;e Su1tes 'Grard Forks 'n5 s`No. 8612 P. I <br /> Burnett County Subdivision Permit Application SubdrvisionFees mustaw/o SPury arkyre $150.00 <br /> and/or Pre-A fication Form survey of Erlsfingparcel $30.0040( <br /> pP Subdivision wl Sun,ev: 5200.00+$50.0D4ot <br /> owner: L'' Buyer; <br /> Q / / Fil Address: Address: X74) /�u5/� LL TEPhone: .- ;r Phone: 7J5—A&J- 76 <br /> ori Inal Parcel Information <br /> Parcel ID Section3 _Township YV Renge3 �w 1 <br /> Original Description(or attach copy): 1 <br /> 2 <br /> :1 <br /> Current Zonis Flood Iain Y/N: 60 _�_ r <br /> 6 P Wetlands YIN; 0 LakefRiver Clasm: <br /> Name of Water Body:_ WA Shoreland Agreement/SIPS YINL <br /> Farmland Preservation Y/N: / Managed Forestry Law YIN, <br /> Ney'Parcel Information <br /> Proposad New Legal Description a Parcel Size: Jl <br /> 3Z t <br /> Acres_ <br /> (If parcel is to be surveyed,provido preliminary map. See attached for preliminary map requiramenu) <br /> Proposed access to public road: <br /> t7 <br /> Proposed access to public Waters to be provided Y/N. . <br /> If yes, describe access. w <br /> Signature of Owner. Date: <br /> Signature of Owner: Dater n <br /> e <br /> > Does parcel mael Zonl�gRegrlirei�ents? Yes ,yo ro <br /> N n <br /> c > Does parcel require a Sloyey? Yes No as <br /> > ParnrilapplIcattonfeessiibatittod? <br /> dmowtt S Receipt d <br /> r- IP Reconciles with Rcal Property Lister Yes No Date: <br /> u <br /> If not,explain: <br /> a <br /> ti <br /> LL <br /> 4 <br /> Applicatl0rit Approved ! Denied tReasonforlDenlalt TFEBLand Use: ZO/ D,teT COUNTY <br /> TOTAL P.02 <br />