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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: S50.00 <br /> Survey of Existing Parcel: S50.00/lot <br /> and/or Pre-Application Form or Map Review Form Subdivision w/Survey: S200.00+$50.00not <br /> CA et <br /> Owner: A r IAA t'�3 e. t'• Buyer: ro g <br /> Address: 5?32( 9oc.k i3t'HowE m <br /> �+ty CAddress: � P <br /> Weir,- 1 uI .9 c <br /> p <br /> Phone: 1 1 S- yy`4ii q 1_ O 4 ( Ty le,-) Phone: U1 `t <br /> Original Parcel Information \ 0 ab? <br /> Tax ID#: q 2 Section L�f Township L Range /5 V4 <br /> Original Description(or attach copy): f i . A 2.7378 2 u #4tr Iv ci <br /> C <br /> a <br /> /�� <br /> Current Zoning: A 2. Floodplain Y/N: A Wetlands YIN: VC s Lake/River Class: •d'i e <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: /f 9 Managed Forestry Law YIN: AA) <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: ?to/eS_ CS'W et-tiack01 �— <br /> N <br /> Acres' <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Ye / by t se01Sri. '� <br /> 1 �h p <br /> Ai Proposed access to public waters to be provided Y/N: O ?x <br /> If yes,describe access: <br /> t <br /> Signature of Owner: u ►g ,�' , AYStMat?� C' Date: '3/30f 23 <br /> Este& a art L4. <br /> Signature of Owner: Date: <br /> Fee Rec: 3 00`5' <br /> > Does parcel meet Zoning Requirements? Yes No s <br /> 7) Check#: 3/3,5 <br /> y <br /> > Does parcel require a Survey? Yes No a <br /> z <br /> z <br /> v <br /> Reconciles with Real Property Lister Yes No Date: <br /> r <br /> H <br /> Iffl <br /> If not,explain: -4 o- CI, ��\ <br /> a (DD C� V r/ <br /> r CD " N UuU <br /> y n iV t=� <br /> Applicatio Approved / ► s aso enial: 0-570e23 <br /> n c NLand Use: . Date: - a'- wusl�y � s,1 o� �l p�o�,�� y aITEI <br /> (� -2)7 <br />