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Fees(must accompany form): <br /> . Burnett County Subdivision 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 For Subdivision w/Surve : $200.00+$50.00/lot <br /> (-5-+ C oc <br /> D © I L .a <br /> fo <br /> Owner: 6 ,(,(Fa. I t I, �Q}'15P!JI Buyers: SC 41Aed 1 B <br /> APR 1 5 2021 J' o <br /> Address: c?$743 �i.)P.1- Address: - . <br /> 32 S 50 <br /> �at�L.bLt_Y C� (.t)1 5'I 3o Lund Se vices Department >z <br /> Phone: 17(S-K( -7315Y(P.Rep)1)4riP io ?"5u2' <br /> Original Parcel Information �C <br /> Parcel ID tt: (:)QC) -4 314-03 /00 (1113 Q54.) <br /> 54)ection f T Township 40 Range / 4, <br /> O <br /> l��-}aLcheo(� a <br /> ( 5e,e,Original Description(or attach copy): a <br /> A <br /> gr:j- <br /> Current ZoningZ -Y.11Floodplain Y/N: (4 Wetlands Y/N: 14 Lake/River Class: iiS A 3 <br /> o (J <br /> Name of Water Body: Nip, Shoreland Agreement/SIPS Y/N; k <br /> ttl" <br /> .o <br /> a Farmland Preservation Y/N: 14 Managed Forestry Law YIN: <br /> a <br /> New Parcel Information ,. r <br /> Proposed New Legal Description and Parcel Size: ( Se_e. <br /> 4+ a-e-A ed ) <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) d <br /> et <br /> Proposed access to public road- 0-00- Qpm art-el 1 'u er ktLLdl �t <br /> Proposed access to public waters to be provided Y/N: <br /> If yes, describe access: <br /> c t ure of Owne�rrd� S Dyt f_ ) ..-----', Date: 4-15-at <br /> t fal.¢,: <br /> Sign ure of caner: �-»--• Date: 'I'/-C'c;76:?/ <br /> W <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> t1 <br /> N ➢ Does parcel require a Survey? Yes No �' <br /> 0 <br /> E. <br /> o Permit application fees submitted? 0 Amount$,1-b°-`,1-b°-`-'' Receipt# <br /> 0 Reconciles with Real Property Lister Yes No Date: <br /> Z4 a If not,explain: <br /> a <br /> a <br /> ; <br /> 0c1 <br /> fl <br /> 0 <br /> rm <br /> a Applicatio I Approved / 1 etued Reason for.40.1110 <br /> Land Use: i 1,12.54 I1-M hoe/a ea% 1 N cA/1/7 iye,Date:A/ N ki <br /> 52 <br /> 5//z/Zv2/ <br />