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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: $50.00Aot <br /> and/or Pre-Application Form p Subdivision w/Survev: $200.00+$50.00/Jot <br /> Owner: b-o oto i c> °� L L-c e lti A,,\ Buyer: At rAetCA, !M Fr-/c r .tiy <br /> m <br /> Address: TOhA.SDf� KIc.ke Rd Address: ki n e o l^ 54. <br /> R <br /> leelo ter 1,41T t' 1.)z 5-V8-C/-'3 <br /> a?il.St Ai nlda _ <br /> Phone: 6 1 14- Sir Phone: <br /> 1 <br /> Orilzinal Parcel Information <br /> Parcel ID#: 07 CSO- -HVY(a ,7-,I- /.s-35$-0/&trCsectiolIn 3a Township Range /(o t� <br /> l Q-1 <br /> Original Description(or attach copy): aeY�y i e _S �S�ce`YeS /—,Is 4- k r e <br /> C2 <br /> 3 <br /> o <br /> Current Zoning: Floodplain Y/N:�J Wetlands Y/N:_ Lake/River Class: <br /> M / ^ �< <br /> m Name of Water Body: ItA Shoreland Agreement/SIPS Y/N:: <br /> Farmland Preservation Y/N: Z/ Managed Forestry Law Y/N: 42 <br /> New Parcel Information t I <br /> Proposed New Legal Description and Parcel Size: A ft.0 S ih�' Ik e tt'`I SS�j4'e <br /> to �i n e s o aS 2 oN2--o��-1"'1 <br /> Acres: S S3 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provideY�N: <br /> If yes,describe access: 1 <br /> IN <br /> / / 1 <br /> Signature of Ow Date: <br /> Signature of _Date: <br /> 9 <br /> C <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> ➢ Does parcel require a Survey? YesAA 11 O No/ <br /> o / �C�� <br /> 00 ➢ Permit application fees submitted? ❑ Amount S /VReceipt# <br /> �. ❑ Reconciles with Real Property Lister Yes No Date: <br /> a <br /> o <br /> a If not,explain:___ <br /> 0 <br /> CL <br /> JAN 6 Mb <br /> Applicatio Approved , enied Reason for Denial: ;URNUT COUNTY <br /> ZONING <br /> Land Use: __ I /3 / �_ Date:—_ ___ <br />