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Pees(mustaccom;any form): <br /> Burnett County Subdivision Permit Application rixlivfsofcEs1t0ingS PYl: sso <br /> .0OW <br /> ot <br /> and/or Pyre-Application Form . : suaivisioawrs,;vr x200.n0fuo,ponot <br /> cvier: :LauraStwickerath Buyer: <br /> maressz 28807 Bluff lake Rd Address',. <br /> Danbury W154830 <br /> Phone 651-336-1014 Phone: c. <br /> N <br /> Original Parcel Infdrinatiort <br /> Parcel ID <br /> or-4)364 °4749-a bs-0oea11a°6.o1edoo,6196® 5eotiost T. hip 40 Range 17 o <br /> #' p <br /> GL8 <br /> Original Description'(or attach copylt <br /> ,g Current Zoning: RR2 floodplain Y/N: N Wetlands Y/N:N Iver Class: <br /> 2 e y Bluff Lake ShorelandAgreement/SIPS YIN; <br /> Name of water Body: <br /> Farmland Preseivation.Y/N:N Managed Forestry Law YIN:N T <br /> New Parcel Information . <br /> CSM.: Combine lots • <br /> t . <br /> Proposed New Legal Description and Parcel Size: • <br /> Acres: f` <br /> • <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.} <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: <br /> 7fyes,describe access: <br /> Signature of Owner: «.n /J/lisA_`CiA,.(—A Date: 4�,-) tea N <br /> Signature of Owner: L Data: el- <br /> �,,L <br /> Does parcel meet Zoning Requirements? Yes No �-t�1rd46�4sf <br /> V D Does parcel require a Survey? Yes No .. <br /> Od t� <br /> > Permit application fees submitted? 0 Amount$ • �� Receipt# <br /> `w <br /> t., $1 Reconciles with, Real Property Lister No Date: 9/15 -.a c� <br /> ,- If not,explain: <br /> i z <br /> 4 <br /> Appllcatlo• Approved/_Denied Reaeo for Denial: , <br /> Land Use: '`�--,✓' C /II7 Ute: <br /> 0 <br />