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1 <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 /> b <br /> H <br /> Owner:Crjr11 frt Buyer: C B <br /> m <br /> `L ( r,CC n,i �c' 0 0 <br /> Address: 7/ `( U .�C11�„�r. CT ST Address: <br /> l O CR-T-,5`fY1-10 <br /> 54 <br /> Phone: (7/5)22.0—z4 Z z- Phone: \ <br /> 1 <br /> Original Parcel Information ,` pq <br /> Tax ID#:07-Gkl0-Z-39-�'/'��j�T-��j�-D/I�ction`�� Township 39� Range /g� <br /> N <br /> Original Description(or attach copy): / Z_ f,<.) /1.h) O <br /> A <br /> �nJ�� <br /> Current Zoning: �K-J3 Floodplain YIN:IUD Wetlands Y/N: /`. O Lake/River Class. rN <br /> Name of Water Body: Shoreland Agreement/SIPS YIN: <br /> Farmland Preservation Y/N: No Managed Forestry Law Y/N: / .)U <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: /J'/2- IY1? Stt) MO) 4.UD <br /> 'l2- 02- 50 /0%J <br /> Acres. t' <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: C <br /> If yes,describe access: <br /> (k) <br /> Signature of Owner:( IA ------- q-z?- <br /> Date: 72 <br /> Signature of Owner: Date: <br /> /,, <br /> Fee Rec: 5: ', <br /> > Does parcel meet Zoning Requirements? Yes No , <br /> Check#: ., <br /> ➢ Does parcel require a Survey? Yes No 6'. <br /> �=r <br /> Reconciles with Real Property Lister Yes No Date: Ic)/3/0a .' , <br /> Nil <br /> If not,explain: to <br /> 3 <br /> C'' r <br /> Rd <br /> c 0 <br /> Application: proved / e d eas Denial: . m <br /> s° ,< I.:Land Use: Date: 1 3 Z4 a 2-. r•3 <br /> � f <br /> AeP � V s 0 IAA e l e4Lica I Q�} c vt PQ v'/fs . r <br />