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TERISCANNED <br /> 7Subdivision <br /> pany form): <br /> Burnett County Subdivision Permit Applicationurvey: $50.00 <br /> g Parcel: $50.004ot <br /> and/or Pre-Application Form urvev: $200.00+$50.00/lot <br /> Owner: Cl{Al2LES -i TNERF—SA BkAMER Buyer: NA , <br /> Address: (?7I NEVAA-I AVF- W Address: <br /> SA\nlf Pavt, M1J 55lI � <br /> Phone: 61 2 . 6 g 5• o t o`d Phone: z <br /> 00 <br /> Original Parcel Information <br /> Parcel ID#:07-OZO-Z-yb44-32-5 tS-357-e19600 Section 3 Z. Townshi yp DN Range 16 I�(! <br /> Original Description(or attach copy): Lor Z. i' 3 CSM 4&1L , t Z <br /> S <br /> 1 <br /> .D Current Zoning: R R 1 Floodplain Y/N: N A- Wetlands Y/N: /V Lake/River Class: <br /> g <br /> e Name of Water Body: YELLOW Shoreland Agreement/SIPS Y/N: N <br /> Farmland Preservation Y/N: /✓ Managed Forestry Law Y/N':� Al <br /> New Parcel Information CJr m V. P o <br /> Proposed New Legal Description and Parcel Size: 4 eC-Ot u'S/ei-/ OF L•LTS z A^1,0 3 (� <br /> CC/LT//—/GD Sz�2✓zFI <br /> Acres: 3, V L <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: ( oi-5 /=/LON T on/ LJ.J oven/ .5-r1zgt r- 0 <br /> Proposed access to public waters to be provided Y/N: LoTS RftC— on/ G H-G ac n/ To •'n <br /> 0 <br /> If yes,describe access: y� <br /> Signature of Owner: <br /> Date: <br /> Signature of Owner: Date: 3 l l 3 it 9 <br /> ➢ Does parcel meet Zoning Requirements? Yes No OK �r n <br /> 3,ait <br /> �-( , <br /> ➢ Does parcel require a Survey? �YY. No a q <br /> 00 ➢ Permit application fees submitted? ❑ Amount$, (D Receipt# o 0 <br /> r., ❑ Reconciles with Real Property Lister Yes No Date: <br /> is S <br /> R' <br /> is w W <br /> If not,explain: N <br /> d d <br /> Applicatio Approved / Denied Reason for Denial: v o <br /> o � <br /> Land Use: Date: j 3 J/ r <br /> W <br />