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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey- Ss0 <br /> - <br /> 0 <br /> 0 <br /> and/or Pre-Application FoSurvey of Existing Parcel: 550.00/lot <br /> rm Subdivision w/S((urvev: szoo.00+sso.00nat <br /> Owner: LrAL� A o.+JRoxic 3 4'u/✓1,p Buyer: _\.tntil c o, dJ acdlVa yw4.)57r6- <br /> n n n <br /> Address: 1 -75o pa v/d i„,4 A[) Address: w 9 5/ 1 oz,;)%n w v a Ile i R n 9 <br /> ChtN 1-a )4t WS { Vq7/ �j (1e// L a K `✓a, 5ygv ??J <br /> Phone: Phone: -7/ S- 4f'C6 a55� W <br /> O <br /> Ori¢inal Parcel Information <br /> Parcel ID#: O oC6- /o a o e 4 o o Section o2 Township Range i _ O <br /> Original Description(or attach copy): (r o V, G o-7 /o <br /> Current"Zoning: L'tic A9t, c Floouplain YiW: N :Veiiands Y/—N; N <br /> Lake/River Classification: WA Name of Water Body: t04 ZA <br /> Shoreland Agreemt or SIPS Y/N: N Farmland Preservation Y/N: Y Managed Forestry Law Y/N:� <br /> New Parcel Information <br /> a <br /> Proposed New Legal Description and Parcel Size: i J cc f---)r �43 o/ 6 f Lcv c Y h h-0 1--a7 ?0 <br /> 5, c71ev owhs{ ,!/1 3 % NOttk of AAI�e lel w , 47 bVTv'P Coyv'7Y i V,l <br /> SC" a_n a cl.c d corgi i�j D«,d Acres: /3 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: N/A t7 <br /> m <br /> Proposed access to public waters to be provided Y/N: N /N I <br /> If Yes,describe access: 1 <br /> Signature of Owner: Q. d Date: <br /> Signature of owner: , Date: Jam'— ��,Z -20,P9 e <br /> 9 <br /> v <br /> e <br /> ➢ Does parcel meet Zoning Requirements? . Yes No <br /> o <br /> o' ➢ Does parcel require a Survey? Yes �� g <br /> ao <br /> Permit application fees submitted? Amount$ Recet t# �Q <br /> As <br /> m ❑ Reconciles with Real Property Liste Yes No ate: <br /> a ,9 <br /> If not,explain: 1 <br /> o C!5 <br /> d <br /> N <br /> Applicati : Approved Denied Reason for Denial: --77 Yea me'6 i k/ <br /> / �nl-•P �ioML <br /> Land Use Date: <br />