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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision wto Survey: $50.00 <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 /> rn <br /> b <br /> Owner: -14,1)'1 12q'"'-S'T�a A.d\- Buyer. co 3 <br /> S9' �Ex t �( Rr Address: 2 <br /> Address: f° c <br /> \le13S're r — , dJ ( 544S.93 `� <br /> FO <br /> Phone: Phone: w <br /> Original c - - <br /> Parcel� Information q <br /> Tax ID#: l( 2/ � / 1 2/q/ /l 2 S J Section ' Township_L1Zange /�o <br /> Original Description(or attach copy): -r- a r= NU./---SW 5 . .S.-- %f,/E- lt/ 2 8o t <br /> cDP lNE 6c1 3cyo ' of T.kE sl c/-Sloe jam. --r- op- 'r/SIE ..!E-SE-- C <br /> a <br /> SEC. C. co <br /> SIN75 "Si A. <br /> tkN` <br /> Current Zoning: A 2-- Floodplain Y/N: Wetlands Y/N: 'f Lake/River Class: <br /> Name of Water Body: A!►4- ^* Shoreland Agreement/SIPS Y/N: / " <br /> Farmland Preservation Y/N: AZ Managed Forestry Law Y/N: A r <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: I Ld� (. S• M , i� <br /> S C A--r7-4-C M c 6 r/1-v f-1 O S t^.p a 1(6.-7Z L,r-./ SkC T-L <br /> it,0 'r ,��-�S <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> I <br /> Proposed access to public road: L` -,k-t Sr-tit,6 1)2 I (/e— is F�c'''." (S c C!'AJ <br /> OR; /AIA-L F <br /> Proposed access to public waters to be provided Y/N: Imo- <br /> If yes,describe access: N'q N <br /> Signature of Owner: �i tutu.` imS-1--re ✓1 Date: 5-i 7-2 <br /> Signature of Owner: Date: <br /> , Fee Rec:56°9. <br /> ➢ Does parcel meet Zoning Requirements? Yes No EA Check#: /72, <br /> ➢ Does parcel require a Survey? Yes No m <br /> r <br /> D <br /> z f <br /> J <br /> v w <br /> MI <br /> Reconciles with Real Property Lister Yes No Date: 1 2-/ll ZO z cnn oo Fi (� <br /> 0 C7 i <br /> If not,explain: V. m . 1ffij <br /> ., w <br /> o QG <br /> 3 <br /> Applicati 1 Approved / t nied Reason for Denial: Pi !It u fJ <br /> rn <br /> Land Use: Date: < ` JJ <br /> m <br /> o <br /> ZOZO3 a <br /> 4 <br /> b <br />