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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application Form Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner: VD,c.,..- f2 '5Tve71— 5C-Buyer: b <br /> to <br /> Address: I 2.3 S AIon.TH Looe 1.1 Address: 3. <br /> 5 rE 7.-e..5-- p2 <br /> F-1 mu.-,re. / %X `�''�'w'°c�3 <br /> C <br /> Phone: Phone: til <br /> t <br /> Original Parcel Information N <br /> Parcel ID#: 1?#' t D 4# '2405-2 Co Section ZS Township 3& Range /6 <br /> Original Description(or attach copy): 7/$rr'r �G Pug 54‘/74,- aP mo $i+,//¢ A <br /> -3 Current Zoning: 4 2- Floodplain YIN: V Wetlands Y/N: f Lake/River Class: (a <br /> Fs' Name of Water Body:�.L4-ry 21.V072— Shoreland Agreement/SIPS Y/N: <br /> a <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 1-6'1- I of Pre-14-i C. 5. ttl . ` <br /> Acres: 34- A-clie".S CA <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: VIA. .Ft <br /> Aic„,„ro g--6.7,$.0 X43 +eVT To o _d <br /> Proposed access to public waters to be provided Y/N: A/ <br /> I <br /> i <br /> If yes,describe access; V <br /> : --------7 • <br /> NI <br /> Signature of Owner: `'1 �-` Le <br /> `''16 v 7 V ` Date: (I —i' <br /> Signature of Owner: Date: 0 <br /> 3 <br /> Does parcel meet Zoning Requirements? Yes No de-0- /QO 3 <br /> tv <br /> Does parcel require a Survey? Yes No <br /> E. <br /> 0° 0.application fees submitted? 0 Amount S 2�Qi Receipt# 0 <br /> CA <br /> r 1S es Reconciles with Real Property Lister No Date: ai XakIS <br /> 0 <br /> e If not,explain: <br /> c <br /> a <br /> o <br /> Application: Approved / Denied Reason for Denial: <br /> a5btc, eat t 1"1 er.T Pi'►Vi's/e'.ti. <br /> Land Use: <br /> 70/Ti4Z/ Date: <br /> -rt4 I S I^e-glAly'c_cl as <br /> a4" er e4"441.f" -LuP-2?__37 <br />