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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 /> 1-1 b <br /> Nrr, A <br /> Owner: :re r r'j D.. Me N 0. 1 1 y Buyer: CT eL v V P , C k ox p(- c\�. I e i" g s <br /> Address: 3 b C, Vi i CG I e 1. C i r•C 1 �- Address: 1 3 I C `I A ; -.i ± 'l R C P <br /> 6c &rSt5bLvc5 . ki'l -.5i-i ?4 6 }}. LL f_ <br /> C"f 1'. %i'fl L U� L�J-9Vv -�^kill 54640 � <br /> Phone: '- 013 0 -- . 3 0 i l' <br /> Phone: `7/_5J- �I.3 i - e. L�.�6 6 � 1 <br /> N <br /> Original Parcel Information <br /> Tax ID#: eti I d. 6 0 <br /> { Section 1.. - <br /> Township . c <br /> ci Range i <br /> Original Description(or attach copy): N K1- +N W $e C. 3-53 `1 - 19 a <br /> &Ale ; ; ' bi-t\i iky /x1 ) e. -t Pcercr.c 6(Fs&rlb4:k b ti cet elo � 6 e ) y ., <br /> 14e 5 b ,..1Y ; k9 &s! t 0-P tk ;"fiFL- (cc L (3 ,:-1 tx.c ; ' ) tz <br /> o <br /> i <br /> z <br /> o i <br /> I <br /> Current Zoning: RR 3 Floodplain Y/N: Wetlands Y/N: Lake/River Class• z <br /> ri 7 <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: rn <br /> En <br /> \/ a r. .Farmland Preservation Y/N: Managed Forestry Law Y/N: '1 e .i > <br /> z t \ <br /> New Parcel Information r <br /> Proposed New Legal Description and Parcel Size: .) a v'.`k 7 I, A o F the C e.51. .3 6 c o f .t iN e <br /> m <br /> NV4AI14 33-.iti-- I9 , 1-his pA.rce ) Ec bL Cc .;\rtckeceet. tt.'ttc� eke (k, -Lc o <br /> p ff <br /> I�l_ N 41 .3.6 3 c"1 1 n (AAA G l'a K i` 6 t S c l: .5 13 a ckL q It) Acres. (°'° i. <br /> i <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Ni%? , Ca(N tie di t G N G tN .1.a ;4`i •- 19 w 1 C.h j c tit C <br /> 6.Proposed access to public waters to be provided Y/N: 5 `�''� <br /> 00 <br /> If yes,describe access: <br /> Signature of Owner: (\:4 -L' j� l61 6 "" 11' Date: / /3 /g o a 1-1 <br /> Signature of Owner: VV Date: <br /> ➢ Does parcel meet Zoning Requirements? Yes No Fee Rec:s,J"- <br /> Check#:707 <br /> ➢ Does parcel require a Survey? Yes No <br /> Reconciles with Real Property Lister le No Date: 1/I I/ 2t17.-il J,L JJ <br /> r <br /> : <br /> If not,explain: n ` L u[Ju Ul <br /> - <br /> CD 74 cffil <br /> Application Approved / nied Reason for Denial. 0 o N o <br /> Land Use: Date: L'i`� ® 'n��,�j m r i <br /> C. / /z oez <br /> L` J <br />