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'AuthentisignID:21008939.6646-4D75-8888-6C87A0F8FD6C <br /> 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 /> 1-1',A p t <br /> at <br /> b <br /> Owner: UkfIl t Let YJ c �f A VoY/*.5 Buyer: it,/. r 'pi E, - g I <br /> v <br /> Kwok .2��6U �� al m . <br /> Address: SS7/� S, Address: vat N� A c <br /> M. *4-69-r%G s)Mi.) cil l q )-4u i. ) PA NI c S"30 4 <br /> Phone: Phone: V <br /> Original Parcel Information q <br /> Tax ID#: / f oZ 1 Section /3 Township_IiRange /� kl <br /> Original Description(or attach copy): /,..671.— ( CSFA -//OA v is% i <br /> M <br /> C'30 1V4✓ /oi 1 61) #2t7tt3 E <br /> Current Zoning: Floodplain Y/N: Wetlands YIN: Lake/River Class. /X <br /> Name of Water Body: 1 r/09..1/ N <br /> LaRk Shoreland Agreement/SIPS YIN: t <br /> Farmland Preservation YIN: t() Managed Forestry Law YIN: Ai <br /> New Parcel Information rc <br /> Proposed New Legal Description and Parcel Size: PdYL1t films di),7ete�e l A <br /> ha 1,F` L h.r.w Q reds o ri-eSe4/. New 1 e <br /> ;s tdiet c edi. <br /> ciAcres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) 0 <br /> Proposed access to public road: �y�t <br /> Proposed access to public waters to be provided YIN: k) ■- <br /> G <br /> If yes,describe acc £i,d..,+: <br /> Signature of Owner: �tdoey.Cl.`Doy/.tee 07/08/2022 <br /> 4,ym o.uo rCDT Date: <br /> nom 07/08/2022 <br /> Signature of Owner: 'p;;t;nin Q 41,iyPpA Date: <br /> 7/8/20A 3:o9:ZI FM WI Fee Rec: $670 '''.11 <br /> > Does parcel meet Zoning Requirements? Ye No <br /> y Check#: o? <br /> ➢ Does parcel require a Survey? Yes t 09 J j 4- le€06 <br /> a <br /> z <br /> 0 <br /> rn <br /> Reconciles with Real Property Lister Yes No Date: Fi r• <br /> co <br /> If not,explain: Y w to C <br /> rda Eil <br /> ' t7C w c= <br /> Application:Cpproved / enied Reason for Denial: PrCD <br /> ^ <br /> nA' < N <br /> Land Use: Date: -V/V/741 z Z' o= N.11W1Z 1 be.JD/ifecJswiJ�t IaX /al /c?34 LL_..JJ <br />