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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: 550.00 <br /> Survey of Existing Parcel: S50.00/lot <br /> and/or Pre-Application Form Subdivision w/Survev: 5200.00+S50.00/lot <br /> t1 <br /> Owner: lUkv 4rAere50, Kllf-7 e#M Buyer: klkV f1 ��80DW SM/tH b <br /> Address: 93// « � ��E 70�� Address: ���� /RUw L4KF C G/}2 g, <br /> R <br /> iffSn / c��/ s y�7.7, w <br /> � / S/�F,� w <br /> 0 <br /> Phone: /IS- 653 ` !123 Phone: /_,oQ `756"ZL 3 <br /> Original Parcel Information p <br /> Parcel 1D#:Q]-()0/v Z-jar/7-3 y-Z O,�Z/^OGO-O//00 Section TownshiQ00 Range 17 <br /> /Y <br /> 11 Original Description (or attach copy): to fy lvw S3 y -7-3,`/t, <br /> ti <br /> .o Current Zoning: f7 Floodplain Y/M m wetlands Y/N: Al Lake/River Class:_ <br /> Name of water Body: /!/ /7 Shorcland Agreement/SIPS Y/N:� <br /> Farmland Preservation YIN: /l�' Managed Forestry Law Y/N: <br /> New Parcell Information <br /> Proposed New Legal Description and Parcel Size: IV lZ NevXy Nw%y 3 <br /> Acres: �( <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: ry(57/N4 10 C-It304JLAKF jL/4-p d <br /> Proposed access to public waters to be provided Y/N:A/ A <br /> If yes,describe access: <br /> Signature of Owner: Date: Q `p <br /> Signature of Owner: Date: /U s <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> gt <br /> o ➢ Does parcel require a Survey? Yes No <br /> °O ➢ Permit application fees submitted? Amount$ . Receipt# <br /> r Reconciles with Real Property ListerJ Yes No Date: <br /> m <br /> 0 <br /> CL If not,explain: <br /> 7J <br /> A <br /> Applicatio Approved /Denied Reason for Denial: AUG 18 2016 <br /> Land Use: - ! 9 r Date: ZONING <br />