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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 /> _ iv <br /> Owner: 74. "(Q. m..,,t cy Lvklz. Buyer: l irie" Lv k-R-/Q FfA.w01Q,& e, i <br /> d ^* <br /> j 31 'I (at M,✓�u rr i 2 <br /> 3!g 4 7 M.Jae, �( Address: <br /> Address: nn nn /l <br /> Jctrt&CYJ LOT- C4U3o 0a,,,,(JUf\j� Li I 543Q \ tit <br /> d 9 X) <br /> Phone: 7I S— 55 J f 3$2`t Phone: 7 f5- 554 /3 o r. <br /> Original Parcel Information N. <br /> Tax ID#: 07-03Z-2-.41--IS-03-I of-0oo-OI-Low-LowSection n'3 Township �I Range )5 <br /> IOriginal Description(or attach copy): S l4 CCNi 4 —Iv/v 6 v- P.{"it- cC -X, I <br /> r F <br /> Current Zoning: RR- 3 Floodplain Y/N: f V U Wetlands Y/N: 'V 0 Lake/River Class: ir <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> m <br /> Farmland Preservation Y/N: NO Managed Forestry Law Y/N: !in ► <br /> 0 <br /> 2 <br /> New Parcel Information b <br /> 330� xl�lQ� ' Let- a� �5i'�t <br /> Proposed New LegalA� Description^ ti and Parcel Size: m <br /> I o r O f / V�4 `'V V 'f - <br /> Acres: 6"' 00 ikru S4. <br /> 0 <br /> IL <br /> (If parcel is to be surveyed,provide`preliminary map. See attached for preliminary map requirements.)) <br /> Proposed access to public road: I`'�S d <br /> Proposed access to public waters to be provided Y/N: 9.! <br /> If yes, describe access: v' <br /> Signature of Owner: at Date: 7/ 3�20ati <br /> Signature of Owner:--.C— a �2'� �' iL ( Date: <br /> Fee Rec:3(T- <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> Check#:/,24.., <br /> ➢ Does parcel require a Survey? No <br /> Reconciles with Real Property Lister Yes No Date: n L. <br /> l <br /> `V°,T C 0 <br /> If not,explain: <br /> 2,-m r N <br /> lullcn ..• <br /> -a- <br /> ID0 = <br /> S O cC <br /> Applicatio1Approved / enied Reason for Denial- <br /> ilia <br /> CD <br /> Land Use: Date: <br /> L.72 / 2oZ� J"J <br />