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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 /> b <br /> Owner: Jerrold Bugged Buyer: <br /> Address:5753 Hwy 85 N 2671 Address: P <br /> Crestview FL 32536 <br /> Phone: 949-632-6164 Phone: c� <br /> Original Parcel Information bb <br /> Tax ID#: 07-012-2-40-15-23-4- 02-000-011000 Section 23 Township 40N Range 15W <br /> Original Description(or attach copy):Lot 1 & 2 CSM V1 P181 NW-SE GL2 <br /> C <br /> `S <br /> Current Zoning: RR1 Floodplain Y/N:Y Wetlands Y/N: N Lake/River Class: <br /> Name of Water Body: Bass Lake Shoreland Agreement/SIPS Y/N: N <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> CSM to combine 2 existing lots <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) yY <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> Signature of Owner: Jerrold Buggert Date: Feb 22,2024 <br /> Signature of Owner: Date: <br /> Fee Rec: <br /> ➢ Does parcel meet Zoning Requirements? Yes No Check#: Cn Op3 7i <br /> ➢ Does parcel require a Survey? Yes No <br /> Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> 0 <br /> Application. Approve' 1 enied Reason for Denial. <br /> Land Use: Date: <br /> % '/ ?,40Z/ <br />