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TO'd 7VS01 <br /> AVG-23-2007 12:05 Remax Horthvoods 1 715 349 7999 P.02 <br /> Burnett County Subdivision Permit Application Fres(mausteomm w. <br /> Smhdi"and/or Pre-Application Form W/s�slsoom+sls.0met <br /> Owner. o n 41 j 7a k r s o bl%. <br /> AddrewAjZ 7 c e,. •.l , /t J Ate, <br /> -- webs+« �, : s�9 P4oae 7�s-y�� =a(a z� <br /> OHeiml Elmd WOM0100 <br /> Pucd umddmtim N: 0 i • 24t/^02 Ss o See&m -2 1Towm6lp39 A Range /7 w <br /> Ode"Deseripttaa(or oltaeh espy): Al:,, Va S to- Yy Sa a .2 i $ 9 N 17 w <br /> carrmt T.enhw. !Ln,a-. J Pleodplain YIN: N Wedsada Y/N: N O� <br /> aLaJwMYer Clad9esttea: Nave of water Rods: <br /> UM PwW feformadam A <br /> pnpmed New Legal Description and Parcel slu: _S yz .41 w 4 S�.• �,� `y <br /> ti s <br /> ,N �- /✓w y4 S t,j yy U <br /> Acres- O o <br /> (tf pared is is tis surveyed,provide pngmbmy map- See:"ached for prehmammy map regdremmts,) <br /> PropwW acotsr to pu61k road: <br /> Proposed mm to poW waten to be peovtded Y/Ai: <br /> 7f yes,descnU aecess: <br /> e <br /> SI tare of Owner. �b� ry den 1 l+ Data <br /> st P Damparedmear7bawgRepdrsmmar? yes No <br /> D Doerpare!mqutroaslo.ey7 yes No J <br /> Y Pamir applie0*ft fee r«bmiaed7 [] emasnr s/ D b Receipt e_l0!'7 $ <br /> 0 Remuflea with Real Property Ys No Date: <br /> a <br /> a <br /> ya <br /> if ook,e:pldn: p <br /> w <br /> SU <br /> Applicl fo A Deeded Rasea fblrpoidah c <br /> W <br /> taw Vee <br /> Date, <br /> 0 <br /> TOTAL P.o2 <br /> TO/10'd 666L 64£ GTL T spoomg4jog xewad 6£:ZT LOOZ-£Z-oav <br />