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ilt a <br /> s <br /> Fees(must accompany form): P <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> and/or Pre-A iication Form Survey of Existing Parcel: $50.00/lot V ' <br /> p 1� pP Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner: f,bS'2M A II-4 l4Zt-c,C7Z_ Buyer: .5+6 E wt.-L.5 <br /> -ac� <br /> Address: 4-41:).2-- Scam-Tsa_,*w` 1 -b Address: FED Be X' 2-35 3 <br /> t4 - 72_. WI s1-s 4 3 n 1::4 LC s 1411 z <br /> /�1✓ac 2- S4ozZ <br /> Phone: Phone: <br /> Original Parcel Information 1i <br /> Parcel ID#: 7'4'x• i LS — .741) Section 1 Township 3 S Range Is t\` <br /> Original Description(or attach copy): L.r / di' el., w /1-/. '($4-N. D <br /> et <br /> 71 <br /> Vol-. , p‘,. /09 , C'. _ AIA, 2 I 7 S8 - <br /> 1 <br /> Current Zoning: Floodplain YIN: / Wetlands Y/N: y Lake/River Class: _Nr4. <br /> ... <br /> v Name of Water Body: 13k /� <br /> 55 £4%e" Shoreland Agreement/SIPS YIN: / <br /> 0 <br /> Farmland Preservation Y/N: A/ Managed Forestry Law Y/N: A <br /> New Parcel Information f^ <br /> Proposed New Legal Description and Parcel Size: L 0 T I Z O uT 4-0 7 <br /> C'F- AI C.5./t/,. — m'- T t--0r To 1c3 E Centvv*! <br /> 1 13,-v-i en_- .'e2 GTt5TiHG 'O Acres: 1..39 e...r�-� r— <br /> ¢.34 6e,7- l q\ <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: t Sri t'✓(n- — T3 tTR-Tx-Ar/►n,. IL b. C <br /> SO <br /> Proposed access to public waters to be provided Y/N: /--1 <br /> rt <br /> If yes,describe access: irkt 4. <br /> -----D <br /> Signature of O i }11'`` Date: / 7 7 ,L i ` <br /> ,,' <br /> Signature of Owner: Date: o <br /> lee <br /> Does parcel meet Zoning Requirements? Yes No g <br /> Does parcel require a Survey? Yes No <br /> °O <br /> > Permit application fees submitted? 0 Amount$ Receipt# <br /> ®Reconciles with Real Property Lister &To. <br /> m p rry No Date: <br /> a <br /> a. if not,explain: <br /> ro <br /> 0 <br /> a <br /> a <br /> Applicatio•. Approved / ,enied Reason for Denial: <br /> C -�!7 <br /> Land Use: _moi Date: 30 <br /> sric%/V1� 7� l JUL1 .- Ccs <br /> D ECE [ivED <br /> ill <br /> 2 2 2021 <br /> Burnett County <br /> Land Services Department <br />