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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision" o Spy: $50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application Form or Map Review Form Subdivision wt Spy: $200.00+$50.00/lot <br /> *4. R.oler -l- 0eb+cz.. Jac.kso" Pe)! I rust ()TO 12/'.4z z 4` 1 A <br /> Owner: P.(jet- if? r `s( . 1 Buyer: /1`1 ic.lnatci 4- \1 LLti e. Sc karps,ter^ d I <br /> 1 ( ,?_/ ( A J m <br /> Address: 27 q q 9 it,�r 1 d`1 Q G P,f') ICt,Y Address: .��7 i � fit. ��u� ?s <br /> W the er , lei 50'93 (,o.a_tack, , t v Z 5 cf 843 <br /> Phone: '716 733 - (OSq Phone: S0"7 - 3r1- a6244I W <br /> Original Parcel Information <br /> Tax ID#: .? f () rQ Section0--Township__V_O—Range / ) 0 <br /> Original Description(or attach copy): C-or Z C5 M # r 96 l - - a <br /> I <br /> Current Zoning: teg Floodplain Y/N; Wetlands YIN: til Lake/River Class: Ai x <br /> 7. <br /> Name of Water Body: (J//1- Shoreland Agreement/SIPS YIN: <br /> Farmland Preservation Y/N: Al Managed Forestry Law Y/N: /`/ <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 4.6 7 S G S7), # _ - - <br /> n <br /> Acres: /d 7 <br /> _ <br /> (if parcel is to be surveyed,provide preliminary_map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 4�i rJ/VG- )2l 0,;(7V4/ �_...___� el <br /> Proposed access to public waters to be provided YIN: AI U.) <br /> If yes,describe access: O <br /> Signature of Owner: '! `" y• Date: 4,7:t..1 5-- '..0 }`( <br /> 7r <br /> Signature of(iwner:,Lb. C Date: - C- Zc :11 <br /> Fee Rec:aS0� <br /> > Does parcel meet Zoning Requirements? Yes No Check*: 77 9 <br /> Does parcel require a Survey? Yes No <br /> Reconciles with Real Property Lister Yes No Date: _ a) <br /> J <br /> Q � <br /> If not,explain: ro E -t 0 <br /> ro n •ro r-: FM <br /> Applicatio,. Approved / i •Hied Reason for Denial• CD S r <br /> Land Use: Date. Fa TH <br /> / Ø& 7 <br /> JJ <br />