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Fees(must accompany forth): <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/Survev: $200.00+$50.00not <br /> Owner: ✓' C ai I''p�ep' aIS�LLC— Buyer: Rt)rnL4 <br /> Address: z <br /> {�eQ f-1�15 . incl 'r L1 raJ.C- <br /> Phone: S $(o co 4'e, ? Phone: l S — 3AB— 2599 Tsar <br /> v <br /> Ori final Parcel Information 0 <br /> -1 0 .30 <br /> -o oov <br /> Parcel ID#: 01-0110- Z-3S-11-Z6-1 01-oo0 -o i1109ection _ZZ Township 39 Range rJ A <br /> Original Descriptionor attach copy): Sce. Pv rr�5 <br /> Current Zoning: Tl- (:7- Floodplain Y, I�: _Wetlands Y Lake/River Class/ /- <br /> o Name of Water Body: /" R Shoreland Agreement/SIPS Y / N <br /> ro <br /> mFarmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Information C-!911-\V-aq , �Z)7—o�owti <br /> Proposed New Legal Description and Parcel Size: ) A'{- I CSm — g,�J QcrtS <br /> 1 2 CSM 40 .�(o� cacrti,S <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) C <br /> Proposed access to public road- C[ `aCth c^ + <br /> Proposed access to public waters to be provided )(k UI <br /> If yes,describe access: <br /> &V _)-%c'-"5 <br /> Signature of Owner:� CY <br /> y ' kAS cC�r'�• Date: <e � <br /> Signature of Owner: Date: <br /> A <br /> Q k _ <br /> ➢ Does parcel meet Zoning Requirements? Yes 70 Jae�'No a <br /> �e r �ir5 a4-I a )� v <br /> c ➢ Does parcel require a Survey? Yes� No Q s <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> ❑ Reconciles with Real Property Lister Yes No Date: �I v <br /> r <br /> � If not,explain: -� y <br /> a d <br /> oQ) <br /> N <br /> plic tion: Approved / enied Reason for Denial: (j <br /> Land Use: Date: <br /> I <br />