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Pcec(must uvcomnnny Juno): <br /> Burnett County Subdivision Permit Application Sundim,ion w/o Staves: Ss000 <br /> Survey Of Existing Parcel Ssd Oadw <br /> and/or Pre-Application Form Snhd,xi,no w/Srvoy: S200 00 FSsoollgnt <br /> owner: JAMIE <# 9171ST id 0jQ CCL KI AIG Rover: 9 <br /> Address: '79X1-9 YAU(4- Address: <br /> L <br /> (,MV ADA CO <br /> W <br /> Phone; 3c8 - 43 L- ') 9S'i Phone: <br /> Original Parcel Information <br /> Parcel lD q: Cr1 4z'Lo 4C ( t3cO Section + .l ixenship 3h Range iS V 1 <br /> Original Description (or attach copy): A5 Oc C CE I^I �ASC-M - T/ A 2CE MENS <br /> 5 <br /> V' "U MC-I�r N^ 42-4.0 )5 AfTAeH CD / �(11LL. //Tr �i <br /> j nJ <br /> s Current Zoning: RiZI Floodplain V/N: Ai Wetlands Y/\:Make/Ricer Class: NA V\ <br /> 0 <br /> Name of Water Body: NA Shorebmd Agreement/SIPS Y/N: NA m <br /> Farmland Preservation Y/N: Al Managed Forestry Law 1'/N: Y 1 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: ONE ` / P-C <br /> SV <br /> CF2i IFIFD <br /> c;"ay MAP n l -S' <br /> Acres: i <br /> (If parcel is(o be surveyed,provide preliminary map. See attached for preliminary neap requirements.) <br /> Proposed access to public road: \1JA RN=— LA K(r IZD �F• 1 <br /> L-ASC-ME�i <br /> v <br /> Proposed access In public waters to be provided Y/N: N \O <br /> If yes,describe access: <br /> Signaturcof Ownec LR/ Date: �� 4 <br /> Signature N'Owner: Date: ,�� 21 ' � � a <br /> V z <br /> Uaes pnrccl mere Zoning R,gauwrneurr? )'es Ago 0K IN �la/INW r�/p <br /> Nx <br /> � . Uoes parcel re9uirea SurvcvV Yes o �G'f/n rvxaQd <br /> i Penni)upp(icnrionfees seebmirted,'r � dmoum$ ReceiptN I <br /> O Rreonciles with Real Property Lis(cr Yes No Date: ----- d <br /> d <br /> 11 not,explain: d L li <br /> d <br /> . rptnirpnninp <br /> rr/y1]I G <br /> Application: Approved / Denied Reason for Denial: VV <br /> Land Use: Date: BURNETTCOIINTV <br /> ZONING <br />