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Fhdi,..e <br /> roan)Burnett County Subdivision Permit Applications o,wa,g Pnaarl: 150and/or Pre-Application Form ,e/surae: 130000+sso owloa <br /> Albert N. Jacobson and <br /> Owner: Gordon R Green (remainder int) Buyer: Parcel $1 tn la nh on _- <br /> Lily Gleason (life estate) 3 <br /> Address: Address: Parcel N7 to Green - <br /> Jacobson: 12246 Eagle St. Nur, Coon Rapids, M 55448 <br /> b <br /> Green: 1374 Co. Rd. A, NLv Richfond, WI 54017 <br /> Phone: Phone: t' <br /> Original Parcel Information <br /> Parcel 11)q: 07-M-2-40-16-21-1 03-O(10-041051 &'lion yl .township 40N Range 16W <br /> C <br /> Original Description(or allach copy): See attached <br /> r <br /> c Current Zoning: RR-2 Floodplain 1'/N: N \Y'cllands Y/N: N Lakc/Ricer Class: <br /> M <br /> Name of Water Body: Sharelnnd Agreement/SIPS YIN: <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information m <br /> Proposed New Legal Description and Parcel Size: see attached <br /> m <br /> Acres: <br /> (If parcel is to be sur,'eyed,provide Preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: County Road W <br /> Proposed access to public waters to be provided Y/N: N CO <br /> A� <br /> If res,describe access: /A <br /> ' /, <br /> Signature of Owner: Df�fM ��/,liLv) Date: <br /> Li ly�.G/l s�n, life to ant <br /> Signature of Owner.sf L /D'vLf{j" /( �-�+'i Dule: 1'3"-f4 n <br /> Albert N. aco son oro reed a <br /> i Does pa+rei+nee!Zoning Regnirr+nenta? Yea No - <br /> Does pn+'ad repoire n So,ve", F"es NO p <br /> as Paxil npph"'hoafees sabmftred? I Ao.ounl$-5-0,OD Receipts p <br /> Ef <br /> - a <br /> Reconciles with Real Property Lister 1'es No .I - Datr.. poC, q1' <br /> � If not,explain: a • I <br /> Applicata n: Appruvrd_ Denied Reason for Denial: <br /> p W <br /> Land Il __ J^^"-�-- Unca O E <br />