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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 or Map Review Form Subdivision w/Survey: S200.00+$50.00/lot <br /> _ 1 w ft <br /> Owner: N l t4©1.\-1 a li t D A Buyer: :w <br /> Address: 15 A U Address: <br /> V2 (,-aGc No <br /> -1-tv CSv,v c -u., i 5-k(>i6 - Lia <br /> Phone: 7 ( - 77 1e> t j i 9>P, Phone: N <br /> G t <br /> �f Original Parcel Information (� <br /> Tax ID#: ( 4B U t' . t(- i Section _lam Township 4 I Range 15 J� <br /> Original Description(or attach copy): O <br /> alb <br /> r <br /> Current Zoning: Floodplain Y/N: Wetlands Y/N: Lake/River Class: ; <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: .-- <br /> I/ <br /> New Parcel Information ii <br /> Proposed New Legal Description and Parcel Size: /n�(�2�Y t VL /0 .r'�&x- x2V'�✓ut(M€ 1-0.11" <br /> o f, C7e,j,t2,1 42 iT41 Kg), t5 �©w�1 c9 Fp LL i 44 Fit; rn44-([)JAltri CO/ 4. let4 <br /> l -tit., L., -1'`�5 f `(��4:1- C_'-it t v^Z-1/4.:,,,-,,RQel ctA 7e,�l,w� ''/ `!'u.c,4v_-`]'Z�b,.ta <br /> X11 Lice¢"fGG,c.�, ig i l/ (f i_• /v11..e.� f 0%I.,L-1.4_ ,,,r- "'�`r e7?1 Acres• io l t W sTrt <br /> l e_Pv°VLGIl LoVK , eTi,l6..,V(—J4-esQ4 121vcxi!2 uie w <br /> (If parcel is to be surveyed,provide preliminary map.pSee attached for preliminary map requirements.) <br /> Proposed access to public road: �b c 'E.f 7 f2Cc ea,G h.4 _f c, , ._....—t-,----` . <br /> Y <br /> Proposed access to public waters to be provided YIN: A f1/0 P(9 'd Q Ad- `0f- <br /> If yes,describe access: C- 14/1 <br /> 15- <br /> Signature of Owner: / Date:---n / /9 2-'Z- (),I w <br /> G <br /> Signature of Owner: Date: <br /> H. Fee Rec:5-0 4o <br /> v Does parcel meet Zoning Requirements? Yes No Check#: c96:21 <br /> )=-' Does parcel require a Survey? Yes No T <br /> a <br /> z <br /> v =g=1 <br /> rn <br /> Reconciles with Real Property Lister No Date: I - ZS-2Z rg <br /> If not,explain: gen Z i fJ <br /> O <br /> Application. • pprov uf t ' .led Reason for De lial• m n. IV <br /> Land Use: 411F11*. 'i /& Z Z Date: <br /> U t ' <br /> K <br />