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Burnett County Subdivision Permit Application Subd $50.00 <br /> and/or Pre-Ap lieation Form Stirvev of Existing Parcel: $50.00nor <br /> L'p Snbdi'Vision�r/Suiti.e,,.: S200.00 k S50.00/10t <br /> Owner: -i JoMEA 64 G 10AJ Buyer: w/tle <br /> Address: Z3 t,77 �DQaGTT 1g t2n4 Address: <br /> �Nr�a2�- G•a-� �t �¢8�/ <br /> Phone: /✓ 2`f Phone: (:—� <br /> Original Parcel Information <br /> Parcel ID#: C)sit. /mots ¢ Section 1•1— Townshie Range <br /> v <br /> Original Description (or attach copy): <br /> Current Zoning: A Floodplain Y/N: PY Wetlands Y/N: IV Lake/River Class: .41 <br /> Name of Water Body: /V. j Shoreland Agreement/Sips Y/N:/ <br /> Farmland Preservation Y/N: /� Managed Forestry Law Y/N: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 4,9�1' / er �fig—u/ C•s• � <br /> Acres: <br /> (If parcel is to be surveyed, provide preliminary rnap. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: /�w/, .4 , <br /> If yes,describe access: <br /> Signature of Owner: (% ��� �, Date: <br /> Signature of Owner: Date: n <br /> c <br /> y Does parcel meet Zoning Requirements? Yes No ro <br /> _ Y Does parcel require a Survei,:' Yes No xt <br /> vw <br /> r- Permit application fees submitted? ❑ Amount S ZDo. <br /> - Receipt # _ C. <br /> r ❑ Reconciles with Real Property Lister Yes No Date: <br /> 'y <br /> 5 <br /> If not,explain: <br /> a <br /> Application: Approved­,(,�Denied Reason for Denial: <br /> E; k-\-9 I U W I <br /> AUG 2 j <br /> Burnett County <br /> _Land Services Department <br /> $vZC�.l7 <br />