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Fees(must accompany foam): <br /> Burnett County Subdivision Permit Application Subdivision <br /> f wi/sti Survey: <br /> veyei: $3 <br /> and/or Pre-Application Form or Map Review Form Subdivision w/Survey. $200.00+$50.00/lot <br /> b <br /> Owner: Jt=o / Sc/ 1 c, Fel'e_v Buyer: --f 4.-q...)/7 S y 0 ef"_i o pi <br /> Address: 7;'?l a,A : e C.t_ Address: 05 3.5-...? 12`l. rld ..S l. o <br /> i-rti-t-r fi N \J'S 3i 5 ere Sct # LZ. -Sgc I @ <br /> Phone: yY7C 3 - 6 e-1,5=.7 Phone: 65 /— 33 7- 7 6/5— i <br /> Original Parcel Information <br /> Parcel ID#: (>7-0/y-2-33-/--3 -S OS--c" Q/a`'° 3S ;45-1,4/ <br /> 'Section . Townships$N Range <br /> Original Description(or attach copy): .2 (= (>� "`-. ,.,0!:tm m-, g wi cF_ Pr t r/t f-).,:r: <br /> Pcr4- o - 64,i i- L o 1- 6 sec 4-,'o., 35, T 38^/, 15 w, G.�4-a//e e <br /> i n <br /> KP--1 . - <br /> Cutrent Zoning: • . , , , . , Y/N: ye 5 Wetlands Y/N: 'I/e 5 Lake/River Class: NI <br /> "ater Body: Sfedleec Leac /A4 C4> t- <br /> ,12 Shoreland Agreement/SIPS YIN; /`� ,. <br /> pFarmland Preservation Y/N: N Managed Forestry Law Y/N: Cl.-,z,Q ac C,,, , (DC-Y' A <br /> M <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: L.°4I PI G(70 S e C•S• M <br /> ',., G ' 4- Lo>t- (o Sec . 3 5 , T3,ti; 2/5v, /G •i''o He#e <br /> Acres: 6.t/3 4-cre S <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) g <br /> A <br /> Proposed access to public road: Ii t 4 l:,�i S f:h �oka,c n P.c-,-.‘,0 4-0 F.ot l2,col .... 1.1 <br /> Proposed access to public waters to be provided Y/N: A/o <br /> If yes,describe access: <br /> la'.I..° <br /> Signature of OwnerAt Date: -2 -,2-5.-'a :2 / <br /> Signature of Owner: ;.S-:�uc2I ?c <br /> Date: �- ,� <br /> ➢ Does parcel meet Zoning Requirements? Yes No G fdG /13S-. <br /> V ➢ Does parcel require a Survey? Yes No °Q <br /> I ➢ Permit application fees submitted? 0 Amount$ 2-.5-0/520-- Receipt# <br /> 0 Reconciles with Real Property Lister Yes No Date: <br /> r <br /> ID If not,explain: <br /> a. <br /> n <br /> 0 <br /> Applicatio• Approved / i :, , Reason for Denial: <br /> Date: <br /> 7:4....,‘_ ____________ <br /> 0730 4/ <br />