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Oct. '24. 2013 d Id M NI ttY tN61NttnINii lv0. 100V_r. Iv <br /> Foos(moat aowmpany Conn): <br /> Burnett County ubdivision Permit Application Subdihsion wl.Survey S50 Oa <br /> Survxy ofExisuag Parcel: %i0.004ot <br /> and/or re-Application Form $20000+se0004m <br /> Owner: u5 ROAV. Via ar Coll, Buyer: TwOn of Scot} MidC ?Cbfmn' ho. <br /> C/o Dw;d c h+ 2$390 C l R <br /> Address: Z/BBO raK4f t S'l. Address: nun end N , <br /> Iu1 ;�nePCao�S IM nI SSVob ST parr W'� 54 Sol <br /> Phone: - 4zD Pnnne: 715- 1035 - 23oe � <br /> Oripinal Parcel Information <br /> 01.0.0-0/Y.0 <br /> PercellDM: 07- 029 - - o-PY-21-I Seenon 21 Township t{O Range_ <br /> Original Description(or at tell copy): G nJ -f4. e, bf?T 1 /'S 711 I J P 1 S� <br /> .Q Current Zoning: C Floodplain Y/N: 'v Wetlands YIN: Lnke/River Class: <br /> a V / <br /> G Name of Water Body: Moreland AgreementlS7P5 YIN, /`f <br /> Farmland Preservation Y4 A/ Managed Forestry Law YN: /V <br /> New Parcel Information 1. ` <br /> Proposed New Legal Deac 'on and Parcel Size: GSM a3T L"ltj - Z1n+t t l0 }l.+ <br /> CGm V, R E 3 ,- <br /> Acres: <br /> (if parcel is to be surveyed provide preliminary map. Seel attached for preliminary map requirements.) <br /> Proposed access to public ad: 6V bw le� +� fy [•r H <br /> Proposed access to public atom beprovided Y/N: N n �, <br /> If yes,describe access: ,� 1 <br /> Signature of Owner: v T Date: i �U <br /> Signature of Owner: Date: � I <br /> e � <br /> ➢ Does parcel meat Zonin Requirements? Yes No <br /> N O <br /> ii ➢ Does parcel require a rvey? Yes No p <br /> 'c' A <br /> °O ➢ permit applieationfees vhmitfed? Amaurst9rl 1 Receipt# W <br /> t. ❑Reconciles with Real Pr petty Lister Yes No Date: SZ) <br /> a I <br /> e If not,explain: 6 <br /> 4 I <br /> ApplicatioApproved D .rd R....a far Denial: <br /> Land Use: Date: <br /> OU-N K l<, �S-lois 3 vs <br />