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Authentulgn IOeD1C9aAA-5695.4928-94EA-5743152F97F3 <br /> Fees(must aesoepany terra); <br /> Burnett County Subdivision Permit.Application Subdivision w/o Survey: sso.00 <br /> Survey of 8aihting Parcel: SS0.00/bt <br /> and/or Pre-Application Form or Map Review Form Subdivision*Survey: $2011.00+s50.00nw. <br /> Owner: 6 a±h r- -eV 2 f* Buyer: f 10 ,f) fp ha L : Q <br /> q ,�^ // / t7 <br /> Address: /13.3 i 41'1 V ie�gq1> W z ij Address: .I/e 1t!t ,fi i° I o , <br /> ar RI&tic i L 3 4s. 47eviektcr, nail 5-D4 ° <br /> Phone: r g 1- `147— /1 Phone: -7'03- 0 _1 / - 7% / <br /> 4 <br /> Oristut*1 Parcet Information t7 J <br /> Tax ID#: /gel? Sectio„ Town.**1 e Range lb <br /> Original Description(or attach copy): r °I-5 /ri A/6 4.).-E ' to u,lf� 4674 I <br /> 7)c - PG # 2..9.6'76S' <br /> Current Zoning: RRA Floodplain me <br /> Y/N;,, Wetlands YIN: Lake/River Class: <br /> Nam of Water Body: l7(.1/I/ ,�// Kt.i Shoreland Agreement/SIPS YWN: AK T <br /> / <br /> Farmland Preservation YIN: t) Managed Forestry Law Y/N; /1►f6 <br /> New Parcel information <br /> Proposed New Legal Description and Parcel Size: L04 3 , L.0 k 4 <br /> 1Z..1•1 a.G"-S ' <br /> )3,91 exctr-es <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: °vlrr' S. (ry 1 I T e-i'I t <br /> Proposed access to public waters to be provided Y/N: g <br /> If yes,describe ac <br /> SiguatureofOwaer J OGt Date: 08/21/2022 <br /> 1�202216697N FM CUT <br /> Signature of Owner: Date: <br /> ,e. FeeRec:_ 300.' <br /> ) Does parcel meet Zoning Requirements? Yes No F,i Check#E: _978'2— <br /> > <br /> 78'Z_> Does parcel require a Survey? Yes No <br /> ReconcilesV ' <br /> I <br /> with Real Property Lister (1g) NO Date: 9-1- a a <br /> If not,explain; <br /> 0 <br /> Application: A graved l enied Reason for Denial. <br /> Land Use: Date: <br /> L '. <br /> ,c...c���,_ 9 d /4p�7...02.�.` t <br />