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my <br />Burnett County Subdivision Permit Application s� tw s $50.00 <br />and/or Pre -A lieation Form surveyofExisim' s PVC5 N <br />PP sumvision wt SWvev 00,00 ; sso.w <br />Owner: R l,.Lg f . Buyer: <br />Ct1at paq �... <br />Addres3- oss 1 JOI RA___,Address: L r2P199 <br />Phone: 7/577 6"- il <br />Phone: X13- YG�3�,ylo <br />ro <br />P <br />Orittlpal Parcel Information <br />Pik a - eyt Seetioa-zai—Township 38 Rause la - <br />Original Description (or attach copy): �� x 71 f'I j,2tlg E3L�'�,,�� <br />va Q Y?�� �1 .A r� �� �. J)ttl it,,, i�.ti L".['''? illd� :i <br />Current Zoning:. Floodplain YIN:-_,--_iWetlands YlN: LskMver Class; <br />Name of Water Body: Shoreland Agreement(SIP5 YtNi <br />Farmland Preservation Y)N: Managed Forestry Law YtN: <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size. <br />ytitcL 1L P. cz u� I Lv f C 5 Vy\ <br />Acres--"?, 5 1 <br />(if parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements,) <br />Proposed access to public road: <br />Proposed access to public waters to be provided YlN: <br />If yes, describe access: <br />A Signature of Owner: <br />Signature of Owner: <br />Bate 4 / ! C / 06-1 <br />Date: <br />> Daes parcel meet Zoning Requirementr? Yes X0 <br />> Does parcel require a Survey' Yes NO <br />i Permit application fees submitleX � Amount $69 b— I(T) Receipt 0 <br />C3 Reconciles with Real Property Lister Yes No Date: <br />If U04 explain., <br />v <br />a <br />B <br />- -- -- .. COUNTY <br />ZONING <br />