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E34/25/1994 21: 22 17156664206 WAGNER SURVEYING PAGE 02 <br /> Burnett County Subdivision Kermit Application inyform): <br /> and/or Pre-A lication Form Subdivision w/o Su Vey $10.00 <br /> PP Subdivisionw/Su cv:$100,00+$1500/101 <br /> Otveer: Ta/w� 44,u 2lhJ <br /> Address: 5g y z ;Is <br /> 6i�C/t 1 Jyl '61 Y9 9_5 Phone: <br /> Orlrrinal Parcel Information <br /> Q O <br /> Parcel Identiflation t! 0'10 - tf 3.x^5-d 360 Section Q?-'5 t,t� <br /> _Township Range //o W <br /> Orillieal Description (or attach copy): ox U I <br /> O <br /> E <br /> Exp C-SM V0 112 P zi z <br /> a <br /> Current Zoning: .�- Floodpiai�y N: Wetlan <br /> Lahe/Rlver Classification: upgomy Name of Water Body: l(iVA�Q/7>LEQ <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: C 51)-) <br /> Acres: 37• <br /> 545 <br /> (If parcel h to be surveyed, provide preliminary map. See attached (or preliminary map requirements.) <br /> Proposed access to public road: <br /> 0 <br /> Signatere df Owner: Date: Q 7 A <br /> T <br /> > Does parcel meet Zm*tg Requirements Yes No <br /> Sa Dors parcel require a Survey? Yes No <br /> > Permit 4pplication fees submitted? O Amount S ` ,5, DO Receipt!! 3 <br /> ❑Rtaweeiles with Real Property Lister Yes No Date: <br /> to o. <br /> a <br /> 77 9D <br /> o urs' G <br /> a L <br /> W <br /> 'gyp Approved / enied Reason for Denial: <br /> s <br /> Land Use: Date: <br />