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s <br /> Burnett County Subdivision Permit Application Sub Sub accompany <br /> w•vviomo Suurve form): <br /> rvey: $50.00 <br /> lot <br /> and/or Pre-Application Form or Map Review Form S b ivisonx tSinu eye520000(+$S0.00/lo: <br /> Owner: \5ot�v.er -I- Se. t'o..� Qo l� A <br /> v <br /> Address: 1\(e.05 W 9.ow I-0..ke •Address: Z• �� i.e," -e- LA'- n <br /> Lk,G k , u31. Ck.s. .•ti.i,l•LA.,, AA A.J.ir <br /> Phone: (008.-(.99 I — eVi 2, Phone: GlZ - e6-1 — GIs8 k oey <br /> Original Parcel Information <br /> Tax ID#: 3 51 ZZ "t- 357 Z \ Section 22 Township 31 Range I a <br /> Original Description(or attach copy): L o k 1 + Lot Z. GSM 4t- SO 21-7 <br /> .co r..wZ e-t Si <br /> I 1--ei t Z. .- L.m+ 3 Gs.•<-. #i 38 Z - c <br /> a <br /> a <br /> ppp n <br /> Current Zonin !1 �\Z, V <br /> g: Floodplai Wetland <br /> Lake/River Class: <br /> Name of Water Body: spv� La.k� s' <br /> Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation YIN: Managed Forestry Law Y/N: <br /> New Parcel Information �, �\ <br /> Proposed New Legal Description and Parcel Size: <br /> S e e ci.+-4--.`c.k GSM . <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: p �T C t Ye m.o.( �'L'.. sv sect- Q L fr. X <br /> Proposed access to public waters to`be provided Y/N: ,try <br /> If yes,describe access: <br /> v-----4 � <br /> Signature of Owner: Date: 41"Z4>Z 3 <br /> Signature of Owner: k,( • 1 - .1c- _ > Date: % -? 7, <br /> eve <br /> Does parcel meet Zoning Requirements? Yes No - Feex Rec: MO, <br /> y Check#: /705- <br /> i Does parcel require a Survey? Yes No v <br /> m <br /> )., <br /> . CD' <br /> Reconciles with Real Property Lister Yes No Date: <br /> D <br /> If not,explain: y �i ., <br /> C <br /> s c`'ro <br /> - v o <br /> z a �"II <br /> Imo o <br /> Applicatio.. Approved / I •nied Reason for Denial- v p <br /> L Use: n w IN <br /> T, W <br /> Date: < o <br /> iFil <br /> - 8' / 0.0e3 <br /> l/ .,[_ J 1 <br /> , <br /> �p/NG IoGG(� /� P1/le' la Gor1' 1 Lfra7"Al' <br />