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Fees(mom accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: S50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application Form or Map Review Form Subdivision w/Survey: S200.00+$50.00/lot <br /> b <br /> Owner: fld 1 4+ >':6l. Buyer: ro g <br /> d <br /> m <br /> Address: 113' i'S'( c./ Er Address: A c <br /> EXc.Lst.%jail.1 NIA 55 ,1 - 1111 r I <br /> lJ <br /> Phone: (gIL- 749 41L+ Phone: w <br /> Original Parcel Information <br /> Tax ID#: 1198.- Section —Township_ Range _ <br /> Original Description(or attach copy): i ar j i 4. Z cF c.04 /Jo. Zit}I vi 3 pi L <br /> O <br /> s <br /> n> <br /> —\ <br /> Current Zoning: I I Floodplain Y/N_ ' Wetlands Y/N: iJ Lake/River Class: <br /> Name of Water Body: NitPPg i•AL GIJ Z1 C Shoreland Agreement/SIPS Y/N: IA.1 <br /> Farmland Preservation Y/N: tJ Managed Forestry Law Y/N: ,J <br /> New Parcel Information 6 <br /> Proposed New I.egal Description and Parcel Size: it.ar 1 0: :.1tio.i Gjm <br /> Tcxt <br /> Acres- I.f 4' <br /> (If parcel is to be surveyed,provide preliminary map. See attached f r reliminary map requirements.) <br /> pe4Rit.,i, 4.) X <br /> Proposed access to public road: eiciSt�Mi 44' t,t►Sj e.itsa," sqr is c.4R.Sowi audit) <br /> Proposed access to public waters to be provided Y/N: 4 <br /> If yes,describe access: `J <br /> Signature of Owner: 7. ._:,1_ <br /> Date: 5/24/2023 <br /> Signature of Owner: \�� - Date: 5/24/2023 <br /> Does parcel meet Zoning Requirements? Yes No i Fee Rec: �0;� <br /> y Check#: 17 1 <br /> > Does parcel require a Survey? Yes No o <br /> zz <br /> 0 <br /> m <br /> pa <br /> Reconciles with Real Property Lister ra, No Date: 6 - S- ZOZ3 <br /> m <br /> N <br /> If not,explain: y <br /> m <br /> 0 <br /> m <br /> -G <br /> Application: Approved / nied Reason for Denial- n <br /> m <br /> La Use: Date: <br /> m <br /> �.; _ 0/27i3 0 <br /> 7 <br /> b <br />