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7/8/2015 CCE07082015_0000O.Ipg(1653x2153) <br /> l3umeti Coll ity Suhdi%inion Permit Application <br /> and/or Pre-application Form <br /> Aw ner: <br /> l .Address )'- 1 D t >� ic, <br /> _�,.{s:�,._._S.t'_L,'__?�ser__�. iddress:_. �'i.::(..3...L� <br /> i <br /> Phone: phone: '7t 3 <br /> _- <br /> 0.6vinal parcel Inft)rmation 111 <br /> t <br /> j <br /> I parcel it)n x�_;: „ 'd Zu Section y i 1)wrship Range <br /> ki _ <br /> " .o'crk 'sv M �* <br /> Original Dewri tion for attach copy): <br /> Current Zoning: _.. � Floodfilain tB\ Mcdand fes_ <br /> Ia412iverClassi0cation: _ tiameof"'atcrl3od+: <br /> S;,,rcland Agreemt or AWS faradand Presenation 1 Managed Forestry Late 1 # <br /> New Parcel Information <br /> Pmposed Nes Legal Description and Parcel Size; a e <br /> j <br /> _ . <br /> . ................ .... ... <br /> Amt s <br /> Of parcel is to ha sur.cpca,prod idc prclitninar., map. Sec attached for pr0i minary seal;requir,r, _.. <br /> Proposed access w public road: _ <br /> Proposed access to public waters 14)'.,e provided% N: ,- r <br /> If firs,describe access: <br /> / ! ` <br /> Signature ofOFsner:r,[�sL. 114 <br /> _ GCS ?"_ [> ir: ZL ..lc <br /> Signature of Owner; <br /> r i <br /> Pod' p i <br /> :.! Reconciles wide Real Properiv Liter 'f ev ?n llate 7 <br /> z t If not,explain: <br /> 1 <br /> Applicatio Approved cried Reason for Deuial: <br /> Land Use: � --� Date: 7. <br /> p EC OVE <br /> JUL 27 2015 <br /> BURNETT COUNTY <br /> httpa/maii.centurylink.net/service/-ar/-lCCE07OM15-OC)OOo.jpo?auth=co&.Joc=en_US&id=6760&p3rt=2 ZONING 1/1 <br />