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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 b <br /> Owner: �J`,Gcv\ Lee - LL)r h�. Buyer: i\/iN <br /> C7 <br /> Address: 1--Ns v ck, y\o) ere eres t Address: <br /> 0 1 L-lrr.b 0--e-l' h+s ,n ti 3-5-1t-2/ E <br /> Phone: (-, i a- 4 l y-0 3C)N Phone: <br /> b <br /> O <br /> Original Parcel Information ck..) <br /> )10 <br /> Tax ID#:01-0 zg- 2-.O-1'`\ -`i'J OS 00 7-Ol/OODSection —Township `�g^> Range \A W <br /> Original Description(or attach copy): 5Ce. ck+xcIN 4 c. <br /> n <br /> Current Zoning: rl i7 3 Floodplain Y/N: /V/ Wetlands Y/N: Al Lake/River Class- ow <br /> Name of Water Body: 'i'(N. . i-er ) Lc.k . Shoreland Agreement/SIPS YIN: <br /> Farmland Preservation Y/N: N.1 Managed Forestry Law YIN: ,i\// ct <br /> New Parcel Information <br /> II r- <br /> Proposed New Legal Description and Parcel Size: ` -l _e e CA 4-40.r ka r j N. <br /> lo <br /> Acres: <br /> /0 - <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: c:�e vl z- G /1OCt i-,2/ `i <br /> k <br /> Proposed access to public waters to be provided Y/N: C <br /> 4t <br /> If yes,describe access: _ <br /> Signature of Owner: c,2� -2 Date: —3)T,=R0.o --1 <br /> 04 <br /> Signature of Owner: Date: <br /> , Fee Rec: <br /> ➢ Does parcel meet Zoning Requirements? Yes No 63 Check#: <br /> ➢ Does parcel require a Survey? Yes Norn <br /> r <br /> a <br /> z <br /> cA <br /> Reconciles with Real Property Lister ilirN No Date: (o -8 -QQ_ <br /> rrl 1rn <br /> If not,explain: y <br /> .n <br /> o <br /> z gill <br /> .< s ' ' = <br /> Application: -pproved Denied Reason for Denial- <br /> Land Us • Date: m <br /> 0 <br /> ZZ 4...........:....), <br />