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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 Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: EO 1-!q e SO�A C) Buyer: TCS 2 y W ®tf�S�Aj <br /> A <br /> Address: -73:p5 H a yeie r LE .-RA Address: 76 73 (fTc-" Rd T- - 3 <br /> 17Qy►_ h I i $s3y pgAl gelf•4 y <br /> Phone: 15 lD S 0 -7 3-H 'k Phone: 7/,S— 'Z4G — -7 / <br /> Orieinal Parcel Information <br /> ParcellD#: 9 Section_2TownshiP �Range f l� <br /> O <br /> Original Description(or attach copy): <br /> G� <br /> Current Zoning: k P3 <br /> Floodplain Y/N: Wetlands Y/N: L4ake/River Class: <br /> m Name of Water Body: U h- V,a w�� Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 9i¢S7— $7/A77f t AJE <br /> Amor e cv YTfrn VkV /raecjgpnpta ® • _gerfov <br /> IeXOA) &-P e-AfJ&? /pct) OF 214 7t4A)dl .acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> m <br /> Proposed access to public waters to be provided Y/N: g <br /> If yes,describe access: p) <br /> J <br /> Signature of Owner: Date: <br /> A <br /> Signature of Owner Al— Date: <br /> 3 <br /> c <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> Does parcel require a Survey? Yes No <br /> -o' <br /> °Q ➢ Permit application fees submitted? Amount$--5t v Receipt# <br /> rReconciles with Real Property Lister No Date:Yes <br /> If not,explain: <br /> A <br /> n <br /> _O <br /> G <br /> N <br /> Applicatio Approved / nied Reason for Denial: <br /> zo <br /> 16 <br /> Land Use: Date: <br /> I,Je s� 2 0 as access rotA7 4 x , e /z96 fe BUFtNETT COUNTY <br /> / ZONING <br />