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I em anml areaonyw for") <br /> Burnett County Subdivision Permit Application ssuuo <br /> Survey or briuma Pa«l iau Damn <br /> and/or Pre-Applicatiofn Urfa smw;.Li.a,./lwrer: SZlsu>n�S5nooaw <br /> Owner: CUFoRZ Amut')DWO Buyer: ADAM CDI �-LC� <br /> ZSY <br /> Address: 3S'1I ST Address: 11 U N <br /> "�2zp c�1\C, �wl X4837 L � e� , �I 54-e� s3 ` <br /> Pbanao _ Lr• 53 ZS-1 -2 rbune -; _ . <br /> f <br /> Oricinal Parcel In fonnatiau {)J <br /> ParcellDN: 07 <br /> IS 34-36Q �sectiva 3�-'I'uwnshih Itangc <br /> 11 U00 � <br /> Original Description(or attach copy): <br /> c Current Tuning: O N Floodplain Y/N: Vah...&Y/N: Lahc/Itivcr Class: - <br /> N:.ua of\Vater Body: Shoreland Agreement/SIPS Y/N' <br /> r,rndand Preservation YGN: Managed Forestry Law YIN: <br /> New 1':vccl InfornuAion / r <br /> Proposed New Legal Descriptiou and Parcel Size: 5 \V . gq- �0 U <br /> -1 AA <br /> Acres: 13 .$ [ FtC <br /> (If parcel is to be surveyed,provide prelimimry neap. See atta <br /> c <br /> hed for prelimivaary mop requirements.) <br /> Proposed access to public road: ` IJ D t jE •t C \,\c L.k F ' <br /> Proposed access to public wafer,to be provided Y./N: 1-3 <br /> If yes,describe access: W <br /> signamrr fOwner: .,O e O � <br /> , e �^/ Dat :.�o '" �Y <br /> sign:nure of Owner: l�µ2�(L WI. w"r�V� Dale: , -,.?6- <br /> �y o <br /> � 0 <br /> a <br /> a <br /> iDors pum-0n.eul%miing Requlre.nentr? � V <br /> ' u <br /> D.parce•I,,quirea Surrey'! Yes <br /> } /'crmil upplieulion/cos suhmiOeJ! ❑ .ImoumS /V/x- NecerplA -Z � <br /> I G <br /> — -- <br /> ❑ Reconciles with Rcal Property Listcr \'es No llata: (�I <br /> If nut,explain: — O W <br /> I <br /> S wl <br /> Applicatmn' A�d Dcnlcd Reason for Denial: <br /> Land M. : Date: 9 Iz za) <br />