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Fees(must accompany form): <br /> Burnett CountySubdivision Permit Application Subdivision w/o Survey: $50.00 <br /> pp Survey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application Form or Map Review Form Subdivision w/Survey: $200.00+$50.00/lot <br /> f <br /> Cc�fi61-//a/SS <br /> ft <br /> Owner:S Ce,4 MCIChg ) J JBuyer: 9"iie " <br /> Address: Address: c;2 7C/ Pda 4 e 71k-14 <br /> Vv1 <br /> Shg.l ) tole L S i27) 5).)1( k 6 2rS 9E <br /> Phone: 76-Li b 5 --- 91Y/) Phone: V'/6' (;' `/ 7 <br /> 1 <br /> C›.) <br /> Original Parcel Information �1 <br /> Parcel ID#:")C&T Jji 3Ac ) Section )$ Township3 Range 11 ) <br /> O <br /> Original Description (or attach copy): <br /> et <br /> /U e. o f S C o f 5e.0--kc )S 7c7 on 5Ad- 25 Pc"-v)) / 2/ , <br /> 4 <br /> Current Zoning Floodplain Y/N: 0Wetlands YIN: Lake/River Class:_ !J <br /> a Name of Water Body: /V 4 Shoreland Agreement/SIPS Y/N: VC) <br /> F. Farmland Preservation Y/N: 4 I d Managed Forestry Law Y/N: C/ til. <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 4, IA 0 c to Se- 1/4f o F <br /> -1-I,e.. Soc,1-'k ems f- �Y cA Seco ion I:-id w6 17,f 3�S 1h�• (i e 6 V <br /> Acres: /0 AC re.$ <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary <br /> map requireemenntts.) C <br /> Proposed access to public road:AryCeSS CS ��ls tea P(7&,, 1,,,c-lite c- e �'re_/� <br /> Proposed access to public waters to be provided YIN: ( N <br /> If yes,describe access: <br /> IT <br /> Signature of Owner: - ... Date: 9---45 ).---2, 2 <br /> Signature of Owner: - Date: 7 C- O <br /> � <br /> CM <br /> Y Does parcel meet Zoning Requirements? Yes No <br /> D <br /> N > Does parcel require a Survey? Yes No ((�� pp �n IE 1► <br /> O <br /> r.cfo ➢ Permit application fees submitted? 0 AmountI$ <br /> -IEVE u V <br /> DCY. on 431> <br /> El Reconciles with Real Property Lister ® No Date: Alizfr <br /> APR. 1 0 2821 1 <br /> If not,explain: - <br /> a <br /> r9FBurnett County <br /> n <br /> rD I and Sprvirae napartmPnt <br /> O <br /> Application. Approv. .4! • 'eason for Denial: <br /> Land Use: 9 ' - 2/ 2.e / Date: <br /> Ae2sie c /rn d—/ A-Z till 1144,-0/-e-C, <br />