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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+$50.00/lot <br /> A <br /> r. • <br /> Owner: (.- v°t•rt ) J'1A _ i. Buyer: C k0 . L--A !1 f.�f ,I- .-I, e r 1 <br /> Address: - _ ' a li . d - Address: 6, 7 0 h; 1%L- g-LriC J <br /> ! — t (,,)",e,1�� L'r S`-( YJ <br /> (� c / Cif / c 1.., <br /> Phone: i/S- , s G,J 4' Phone: 7 IS • 7 4 / UCS' 9�3 <br /> t <br /> Original Parcel Information <br /> olt000 <br /> Parcel ID#: d 7.01<(,_,2,..39.1`,-p�7- y -o2,00a• Section Townshipk.24.C5 Range <br /> O <br /> Original Description(or attach copy): m <br /> 9.'r ? <br /> co <br /> Current Zoning: Floodplain Y/N: /Ve Wetlands Y/N: la) Lake/River Class: /1)/) <br /> Y Name of Water Body: Shoreland Agreement/SIPS YIN: <br /> v <br /> Farmland Preservation Y/N: / Managed Forestry Law Y/N: Aid .7----- VI <br /> New Parcel Information N' ra <br /> Proposed New Legal Description and Parcel Size: See 814ached emei 4 <br /> 1:b; <br /> Acres: /0 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) d <br /> Proposed access to public road: `' #5 67.5-, F k I? a _. i2� (Drt'u & / <br /> ` e„ <br /> 1n tC� <br /> • 'Ie � <br /> � <br /> Proposed access to public waters to be provided Y/N:/JO l <br /> If yes,describe access: <br /> ?-1" ,,Z <br /> Signature of Owner: �_ Date: /0"` 1"2 <br /> ` <br /> Signature of Owner: Date: <br /> D Does parcel meet Zoning Requirements? Yes No AIuno3 uewnti___ <br /> ri <br /> c ➢ Does parcel require a Survey? Yes No ZCZ IT _ no <br /> Pcniermit application fees submitted? 0 Amount$ l • Receipt# /' If <br /> �� ` J ali <br /> 0 Reconciles with Real Property Lister in No Date: ,-5-- E R A <br /> iv If not,explain: applica•lion Is accepted SCS long 8S error uJiii \n proposed 19611 desc. <br /> e <br /> z is corrected. Set attached. <br /> a. Applicatio A rov enied Reason for Denial: <br /> Land Use: /07Zea/ Date: <br /> POO 427L erect ,h /77/,, see c,/4.4a, <br />