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rSubdivision <br /> must--Pang form): <br /> Burnett County Subdivision Permit Applicationvision w/o Survey: f50.00 <br /> and/or Pre-Application Form yof Existing Parcel: OM of <br /> w/Survey: 1200.00+550.00/lot <br /> 13svtter: WAILIE d L Ch8Ee fyyn: (,UiLLIf� M jli.M/Y1 Cl' <br /> Address: _ V 3_J�) -H6a IC I t()Li CI Address: 6050 L. I t-I f,-- / I 3 <br /> M-b_ lr, Itis �LISg3 IU�b�tzt Iili Jy�i3 <br /> Phone: ' 115— DfJ f7 —�I l l l Phone: <br /> L <br /> C3 006ri2fin11 i1a,reel In formation) <br /> Parcel ID 9: UT OZo -Z' Ie'I6'"3E7-3 eVCgection EJ Township 01 Rnnge �(��l/ O <br /> Original Description(or attach copy): L41 CS/')A V'C) 7 <br /> 5c 5V / Lei VZ3 P9' 63 `— <br /> � J <br /> Curren)Zoning; r— <br /> �.� Floodplain Y� � Wetlands <br /> Lake/River Classification: �- Name of Water Body: <br /> New Parcel Information 033 rr/�5 • 5� —� <br /> Proposed New LegoI Description and Parcel Size: - ✓.0/1, I L UT Z} P,til D <br /> Acres: _37 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Co V� O°l CI A- <br /> O <br /> Proposed access to public waters to be provided Y <br /> If yes, describe access: <br /> /? <br /> / = r <br /> c Signature ofOwner:X I JL /IlQ � (Jw Date:X <br /> v <br /> Signature of Owner. \n Q f„ \!.( ; ., [ L/Lf,.�Lt� Date: I— .z <br /> 3 - <br /> 'c <br /> > <br /> Does parcel meet Zoning Requirements? yes No C L <br /> I'/c "I <br /> > Does parcel require a Survey? yes No a <br /> J <br /> ? 7 Permit application fees submitted? ® Amount s 30,).l'n Receipt# g <br /> n <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: g <br /> QQ� T <br /> c, v' <br /> g <br /> Application: Approved / Denied Reason for Denial: n 1. <br /> UI <br /> Land Use: Date: <br />