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fen(must accompany form): <br /> Burnett County Subdivision Permit Application Subdirisiana/o Survey: $50.00 <br /> and/or Pre-Application Form Surveyof,i.,l/S. Pa d:'S50.00/u1 <br /> .r�Q 1 / n /�� pp Subdivision is Existing <br /> : 5_00.00+550.00/lot> 1 3C�p <br /> Owner: 1J I V F_ � Af LIE/P_50/s/ Buyer: <br /> 16g6 Hwy y� <br /> Address: Address: <br /> FREDE2�L � pW� 5yg3� <br /> Phone: 115- 3L Phone: Cl' <br /> O <br /> 0-7-07-0- Z-Y0= !lrzd-5 VI <br /> 7 Original Parcel Information LT� <br /> y�19.5i <br /> 5- - t3 gOde, <oT5 <br /> Parcel tD q: 7-hi-"L /j-ham-/6 rodp/- /�1 Section Z(J Township Vak/Range K O <br /> Original Description(or attach copy): <br /> Uld 61f /9 /// LL_f�6Zff <br /> �acllGu� Gulf LUr l — 1� r1 <br /> V NWq 5E RNo 5W 5E <br /> Current Zoning: �h / FloodplainON: ? Wetlands� /&N: / <br /> Lake/River Classification: Cl-/IJS ' Name of Water Body: yL (4l zQn/�- <br /> New Parcel Information y, dy r, a$I-a6)d <br /> Proposed New Legal Description and Parcel Size: L 5 m "' 3 LO7-� <br /> Acres: 19 <br /> -6JC <br /> (If parcel is to be surveyed,provide/preliminary map. Seepr1 attached for preliminary map requirements.) <br /> Proposed access to public road: LONG r 1 N� (t oa loko: rc,7re <br /> r <br /> �- x v �j <br /> Proposed access to public waters to be provided Yo <br /> If yes, describe access: Fl r71lQJ�nI > l fl?LLfL "�+ <br /> 1 9'' <br /> r c Signature of Owner: L Date:,J <br /> 0 <br /> e <br /> a° Signature of Owner: Date: c <br /> 72 <br /> Does parcel meet Zoning Requirements? Yes No <br /> v r Does parcel require a Survey? Yes No l�-ly la ✓� x <br /> 6 <br /> F > Permit app/icationfees submitted? � AnrountS 3-5b•00 Receiptk�� <br /> 'o <br /> c <br /> ❑ Reconciles with Real Property Lister Yes No Date <br /> If not,explain- <br /> App <br /> � Approved Denied Reason for Denial: <br /> Land Use: Date: <br />