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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> and/or Pre-A lication Form Survey of Existing Parcel: $50.00/lot <br /> PP Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner: E✓11 v 1 e If f c GL '1 i ) A ,-.r, <br /> °� �� �. Buyer: I � � N, r� '�f <br /> eD <br /> n () C 1 Q. (�Cti L <br /> Address: 1 c3 �)Q.7lit roi x Address -14 0 TL /to 1-- b Y- 2. <br /> J 7� <br /> cup b i,i✓ _��t s,3 C'' 5 VI) clati I V ;) I �`-i- <br /> Phone: 1 S 4 5 ci2' 3°c:�� Phone: I 0`k (cc3 - x7 b 7 <br /> N <br /> Original Parcel Information , <br /> Parcel ID#: 3ca?ly Section 3(o Township 4 I Range 17 <br /> 11'' O <br /> Original Description(or attach copy): Al 11 L AL SE I%( SW 1/y c F. <br /> ep <br /> S3(0, tiIA/, 2 ID ca. n <br /> 4-z ce <br /> - <br /> Current Zoning: Floodplain YIN: N Wetlands Y/N: Al Lake/River Class: /V/4 �C <br /> • <br /> S <br /> aaf ' <br /> Y/ <br /> Name of Water Body: /Vf/4' Shoreland Agreement/SIPS Y/N: A' <br /> Farmland Preservation Y/N: Al Managed Forestry Law Y/N: N <br /> New Parcel Information o <br /> Proposed New Legal Description and Parcel Size: IV Alif 2 • r 41 1/2 0 L S E l/y Swill T <br /> ( S it of 4C /V72 6c se 'hi s-. v <br /> Acres: 10 L u'ei <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 30'FL L,,..s ..L. L.e vL. !.cc.cs t 4 S4, Cr.',r f rc', 1 t7 <br /> a <br /> Proposed access to public waters to be provided Y/N: AlieD <br /> d <br /> If yes,describe access: <br /> c) <br /> Signature of Owner:, l�J.t;u--• A."...-4.--- Date: /0/03/ 2 L (`1 <br /> Signature of Owner: Date: 0 <br /> 0 <br /> 2 <br /> ➢ Does parcel meet Zoning Requirements? Yes No o <br /> N /5ec- ' <br /> °o > Does parcel require a Survey? Yes No %°lip l <br /> 5. <br /> °° Jc3 <br /> ➢ Permit application fees submitted? ❑ Amount$ � ` Receipt# 1 <br /> J <br /> t ® Reconciles with Real Property Lister $(3's No Date: )p- 14 -as •- . <br /> Im <br /> a. If not,explain: <br /> 7O <br /> et <br /> et <br /> n, <br /> y <br /> Application:(Ap i/ Denied Reason for Denial: <br /> 2 • y 4 - <br /> Land Use:Ai, (�-u— /0/0,0a Z_ Date: <br />