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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+$50.00/lot <br /> v, eD <br /> b <br /> Owner: D V i 0 U'-/.£A DLL Buyer: M S 'ban 1 1GtYlclr lSey l f9 -. <br /> v <br /> S S 1.vett LK- ld`T(�1' 5.Iv►e-C L tr— FA eD o <br /> Address: �. Z dress: <br /> C)11•4 u1S FAA 1 . c4P 40 6-ra h 10 u,� tAZ Sit ,S '4 <br /> 0 <br /> Phone: Phone: -43---Sstc(a _ 4( 4 ( TA, <br /> Original Parcel Information Tax ID#: 3Z4/� ��3, Z� to _ St Section _Township 3$ Range Ica 0 <br /> Original Description(or attach copy): e tprx c,, tire_ to i-.. /M pry(U <br /> ,/ O <br /> a <br /> A <br /> t.1«3 Current Zoning:iqt . Floodplain Y/N: / Wetlands Y/N: <br /> Lake/River Class: <br /> Name of Water Body: LA IL (A)t a d. LG. I--t----- Shoreland Agreement/SIPS Y/N: , <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: n <br /> New Parcel Information 3 <br /> Proposed New Legal Description and Parcel Size: Lb 'I' lj c N. Li (o4'; <br /> a(P aetA €%Gl'1.an,C. Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) ya <br /> Proposed access to public road: X <br /> v <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> Signature of Ow Date: /t 1i3 u11 <br /> Signature of Owner: '1"1 7-'"( Date:/2 —., C36-9- <br /> -� Fee Rec: 3OO `� <br /> ➢ Does parcel meet Zoning Requirements? Yes No = Check#:.9)$fl <br /> > Does parcel require a Survey? Yes No ° <br /> r— <br /> a <br /> z <br /> c r <br /> cn <br /> nrr <br /> 71 <br /> Reconciles with Real Property Lister Yes No Date: F) w <br /> � a <br /> If not,explain: a <br /> 2*co <br /> m 3 n <br /> o 0 (D <br /> -< Oo o 0 <br /> A <br /> Applicatio Ap roprop ved / %enied Reason for Denial ,m, .. c <br /> m � <br /> Land Use: Date: < <br /> 0072.oz4/ <br /> > Lc Jl <br /> a <br /> 4 <br />