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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: $200.00+$50.00/lot <br /> � V <br /> ` I / b <br /> Owner: Luv\‘ of (ew:A & dOvQih))Buyer: Va,Maft(\ TrUI1- inelA\SSa. a e3 <br /> Address: (5209- Loki` 2�c it-oad Address: \0 -1 A Rd?e C kr- o <br /> 1cknbu (L\ Lk;t SL-t%30 \refer Cw ve k--1t(VIts ;in ki <br /> SS0.} t'1 <br /> Phone: -1 k • tp ()lo' 5122 Phone: Lt t a, •a 81) '7-..):2)- \ g <br /> Original Parcel Information <br /> I AJ <br /> Tax ID#: 2-1 C1-1 S Section 25 Township 4 ` Range 1 <br /> Original Description(or attach copy): .`sL e Ck. +\d C. he d O <br /> n <br /> Current Zoning: 6"1- 1 Floodplain Y/N: N Wetlands Y/N: tV Lake/River Class• kn r <br /> , <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: Nk Managed Forestry Law Y/N: N h n <br /> — <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: See. O Il 0.C he d <br /> Prippese_c/ CS` " ' Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: D1I e CA- a CCt s s . L& t 2u 8 <br /> Proposed access to public waters to be provided Y/N: N v <br /> It <br /> If yes,describe access: <br /> Signature of Owner: Date: AO: , C.21. _ .Z.__- V <br /> ( 1 <br /> Signature of Owner:111\ Ci:/ i Date: O a /(� (2-0 -� v <br /> Fee Rec: iD <br /> > Does parcel meet Zoning Requirements? Yes No x <br /> Check#: C0c/ <br /> > Does parcel require a Survey? Yes No <br /> tvt- <br /> ›. <br /> Reconciles with Real Property Lister Yes No Date: �ec 'g <br /> rn c -r1 <br /> cA <br /> If not,explain: a 3 W (`lr <br /> s <br /> 0 <br /> e _' 0 <br /> Doo c <br /> c .7, <br /> Application• pprod d Reason for Denial. ,_, <br /> tLi Land Use: ,//6/7-0 ZZ Date: 3 . 4� <br />