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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+$50.00/lot <br /> /q rtik 4,3. f/a.1 c��15Cr i 1 ,b <br /> Owner: Va.ri-toA-1 A Yfr''- LSL5 t r^-Lh Buyer:CAIS .ncArc-1-/'('r`�.Jr•) ndc'-'5 r1 B <br /> t <br /> Address: /U f/7 51'ci-le- 121. 70 Address: 6,.1-1 \v.-C, Sr- <br /> cA <br /> C� i r e vN (}..i t 5"(Si?Z a. rc n T5 a, cc;, e fQ <br /> CO <br /> Phone: 7 .7 - 1 "-2 31O Phone: <br /> Original Parcel Information <br /> O <br /> Parcel ID#: c 7 -a 01-3e -i7 - <br /> is-y u_2., 0ex i- . Section / Township - Q Range /-7 <br /> O <br /> Original Description(or attach copy): /)r✓.5 C 3 / . / .3e'-0 A /7 i. 4 <br /> a <br /> i <br /> Current Zoning: 9— Floodplain Y/N: 4/ Wetlands Y/N: / Lake/River Class: c-a <br /> 3 <br /> . <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> dFarmland Preservation Y/N: / Managed Forestry Law YIN: ,C.) <br /> o <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: Al 3y ,Li i-J S i?----- i <br /> Nt 36 nuts Nei s� ci: <br /> Acres: ± 3a Ate-r ''--Sih' <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> o <br /> R <br /> .. <br /> Proposed access to public road: N <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> W � <br /> Signature of Owner: • � . ��� Date: �� ^lj Z <br /> Signature of Owner: Date: <br /> > Does parcel meet Zoning Requirements? Yes No .CIE V E- W <br /> t <br /> t ➢ Does parcel require a Survey? Yes No <br /> o <br /> E. ��o 4 DE 1 1 2023 <br /> CfQ > Permit application fees submitted? 0 Amount$ Jv"— .27/9 1 IReceip # i <br /> 0 Reconciles with Real Property Lister Yes No Date:\3'4� ur Iceett Depa <br /> r Tf <br /> a If not,explain: <br /> o. <br /> r) <br /> n <br /> 0 <br /> o▪. <br /> Application: pproved D ' eason for Denial: <br /> Land Use: Date: /7/0 Z.3 <br />