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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 /> Owner:J O L 0 Yof-OJ.y Buyer: VI") Cr.,`[_4 bh F. <br /> 23t Z CA, J -7 Lo# t °° <br /> Address: v,r+k y F{ Address: .. <br /> 5hel I Lo,Y-c1 tA1 54c7 I I <br /> \ ; <br /> rn <br /> Phone: <br /> 1 l 5— 1245 — 27 35 Phone: <br /> Original Parcel Information <br /> Tax ID#: 32-.G J( �A\ 13206 Section )te' 38.Township Range 14 <br /> Original Description(or attach copy): it <br /> 0 <br /> e+ <br /> Current Zoning: fir Floodplain Y/N: 4 Wetlands YIN: V( Lake/River Class: <br /> Name of Water Body: &Arai) Cite,IC— Shoreland Agreement/SIPS Y/N: F e• <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: sa <br /> ?G <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: L_e,4- I 35.5 I a Cr5 <br /> 1--i2 f z 3.1 o 4 c e-c s <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: e vtS 4.4 , dr i 1t'e cv c41 <br /> Proposed access to public waters to be provided Y/N: /" 1 5 <br /> If yes,describe access: _ ,.. <br /> Signature of Owner:X V Date: a IZL(7o23 ` ,g. <br /> Signature of Owner: Date: <br /> , Fee Rec: 3 QO/ o^ <br /> > Does parcel meet Zoning Requirements? Yes No <br /> Check#:S?, 9' <br /> ➢ Does parcel require a Survey? Yes No 6 <br /> i <br /> x <br /> o <br /> r m <br /> Reconciles with Real Property Liste Yes No Date: ( i 12(�t�� ri< i-aL <br /> y Q ilifg <br /> If not,explain: i g w m 0 <br /> r= <br /> Application. �prov / 'ed Reason for Denial; , / m 4 ro <br /> Land Use: r Date: /j Z 2O a3 i m Fill <br /> d9 <br /> — X/4 74, //y- ofr Zev7L 2 ,WI 3 ' -/2 . w ' . <br /> o clwe !li 1 /Q1 GW mei Zf ! er,ex�lus i' cl eiemu/Aug <br /> N 9 <br /> P � 9 <br /> uh/eSS if' JA.4e.e./71S HI0Se- YeVA/re414eh , <br />