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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 /> A) D C1411,-DS 451 L'I �'" y IV <br /> Owner: 13.��r:s Jahh � �awaes Ghtlas ° 1§ <br /> p \- �, m <br /> Address:283 I95De\e,iIfk Address:a c3 'v�,1�, 0 0 <br /> k)ek r LAE' Sc?''3 K c <br /> Phone: (711 ') Phone: (71 Is', 3 7-2-5-1 t y <br /> i' <br /> Original Parcel Information <br /> Tax ID#: 555 3 dna . 04i40 Section J4 Township �0L Range 15 W C <br /> Original Description(or attach copy): 5l0'4 ' Ai g 114 5E /� of y4: V tofs a <br /> -3 el> <br /> S!POD' of E/e(oc7', 64. cs►& <br /> y _ <br /> Vol. 29 10, SI (1 R,4AB) S" <br /> e <br /> a <br /> z <br /> v <br /> Current Zoning: Floodplain Y/N: Wetlands Y/N: Lake/River Class. z <br /> Name of Water Body: W7' 1'lb w" Siov611 s Shoreland Agreement/SIPS Y/N: f\l m <br /> Farmland Preservation Y/N: /J Managed Forestry Law YIN: VilildMulh L <br /> 0 <br /> New Parcel Information t- tfl <br /> Proposed New Legal Description and Parcel Size: . Jt sk1?) OF' refry per kik?oF Solve. , <br /> 64 <br /> co c -Eire ao Acee Sw'NE. akotib 74 Agri wig be ' Vt4.2h r A: .324 A,urs p9'Al Er <br /> for 4,14 5 ) , (41.3 A4los17)04 l h"wu 60664 stoat /O Acresj~�eJtiY,1 a" 9.0 dais z <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: �(►ke,I "A" D 1N id fora 8 f W l IKeU14 /QJ G <br /> 1 r <br /> Proposed access to public waters to be provided Y/N: w <br /> !floor desexilaieaseess+ Wore: &a CorWasotitsoacatirts, Actr¢o s of a g rosr. <br /> !WWII e'V/77- •- <br /> Signature of 0 �^ Two, <br /> Signature of Own Date: <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> 4 I00"o2 Fee Rec: )SD.`�Check#: 118.55- <br /> ➢ Does parcel require a Survey? Yes No 4e 7`.A� <br /> axe <br /> Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> Applicatio : Approved erred Reason for Denial. <br /> Land Use: —_______) Date: <br />