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Fees(must a companv form): <br /> Burnett County Subdivision Permit Application Subdnision e o Sunev 550.00 <br /> Suney Sur <br /> %c% <br /> Existing Parcel. 550.00 lot <br /> and/or Pre-Application Form Subdivision" Suc% 5200.00-S50.0olot <br /> Owner: ECILocif•A Cc 11c7VCti Buyer: <br /> Address: 1'/.?)0 6-e v)t? �c�c9 �1 t/o( Address: 3 <br /> �u o, IN1 V\ S 5(,.3� � <br /> Phone: (e 5-1 ' .2L-I - (C 833 Phone: <br /> Original Parcel Information <br /> Parcel ID#: (7 ]-p ZO-„?-NU I(o 19 J /j=,3j�U r( yr7L�Section_L�Township cfy Range / J <br /> Original Description(or attach cop-, 772 KSe” Lc)'K P S kr✓re' <br /> �e tl o w Lci"k e_ L.c f/a Al =k I i <br /> 7 Current Zoning: Floodpl NN'etlands Lake/River Class: S_ <br /> v Name of Nater Body: i e�l0c L-�KP_ Shoreland Agreement/SIPS <br /> o � <br /> .. Farmland Preservation l"(N:J Managed Forestry Law Y(N:/ _ <br /> New Parcel Information V�� , 3 —� <br /> Proposed New Legal Description and Parcel Size: �(Xez,, C<S yy\ <br /> Acres: .3 C&U <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> m <br /> Proposed access to public waters to be provided VN: <br /> If yes,describe access: <br /> Signature of Owne . Date: <br /> -- J <br /> Signature of Owner: pate: <br /> 0 <br /> C <br /> > Does parcel meet Zoning Requirements' Yes .\O <br /> A <br /> aDoes parcel require a Sun•er•.' Yes No <br /> 0 <br /> >e i Permit application fees submitted.' Amount$ _ Receipt= <br /> wO Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> application ppra / Denied Reason for Denial: <br /> P 13 ZTMT T_ <br /> Land L se: /tP Date:__ <br /> / / ZONING <br />