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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+$50.00/lot <br /> Owner: qgeSOrrtArf-ut 14e-LLC'/Z_ Buyer: .S+E E e't-L-5 <br /> Address: 474D-2- 45 12-T-"-01--14,\ .b Address: 1.P° 3Bx 23. 3 <br /> 1,467cbn1-c 12 - i 5-1-093 TZi ✓irz - r=4LG5 , U" S40Z2_ <br /> cfa <br /> Phone: Phone: <br /> ka <br /> Original Parcel Information <br /> t <br /> Parcel ID#: '7q.y• I G� — ,4 / 1 Section I Township 3 8 Range /r C <br /> Original Description(or attach copy): LA. r / app. cl se /4-4� C-5".. <br /> do L. �- P6 /c cl C)bC. AID, "ii? S-8 ¢- :,,,, <br /> in Current Zoning: Floodplain Y/N: y Wetlands Y/N: if AZA--Lake/River Class: N� 4. <br /> a Name of Water Body: 13A-55 G,4I*E Shoreland Agreement/SIPS YIN; A <br /> N <br /> / <br /> Farmland Preservation Y/N: Al Managed Forestry Law YIN: /`� <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: L 0 T I b c.4.T Lo 7 / 16 <br /> o "lei," C,S. .4,,. — m'- 1 mar To 0€ Cewvt <br /> e'. 39 et.,-4..v-c-0.1-- <br /> __ __A/ <br /> .-..v-c-0.-r- <br /> ,' /L4c t"0 Acres: it...3¢ Go 7- f ( ) <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: t S -.1 y is — 132-o-z_iv n,� rt,....,..,. <br /> p <br /> a <br /> Proposed access to public waters to be provided Y/N: /J f9..0 <br /> If yes,describe access: Ai.4. ' <br /> & .... ... <br /> Signature of Owner: e-e- St1Z at -gz -Gyr '&' Date: sviaA/�_ fu <br /> Signature of Owner: Date: o <br /> Y Does parcel meet Zoning Requirements? Yes No eo <br /> S <br /> Y Does parcel require a Survey? Yes No <br /> °Q ➢ Permit application fees submitted? 0 Amount$ `r5- Receipt# <br /> r tEl Reconciles with Real Property Lister 0 No Date: $/11/a1 <br /> ID0 <br /> a. If not,explain: <br /> f <br /> 0 <br /> 0 <br /> O <br /> O. <br /> y <br /> Application- pproved s enied Reason for Denial: <br /> F <br /> Land Us/ `/7/ZD Z/ Date: <br />