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Fees(must accompany foryt�­-, <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: 5000 <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application Form or Map Review Form Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: it / / ✓ /� M A �< u I? Buyer: %HAD 0.560RAJ C 3 <br /> I SSE - '2LZ s '` <br /> Address: `177 ' A /� /t=L Address: 0�7`lo5 CouN-+q 20 q o <br /> A<IGL�, illitl 55�D3 <br /> 5goo 93 �LP <br /> C4koL XrY 7/y (X7 <br /> Phone: �//� - (a35 ��°�� S Phone: 7/5- y16 - 3ZElS <br /> Ori final Parcel Information C <br /> 07-tay tFD 14 0�9 5 Cv-Obl 611D06" "I ' <br /> ParcellD#:0OOa8'd'40 14 a9 a'DI bDU h15dD6 S�c lA <- Township �U Range A <br /> (// z <br /> Original Description(or attach copy): &L I o as- Tja9__0l guD <br /> K02 n)k LL a_24-LY2 =al-7nr) <br /> F I ,n,;�� yLJ ^IVI <br /> Current Zoning: /'- 41oodplain Y/N: Wetlands Y/N: / D Lake/River Class: N 0�Lc <br /> D Name of Water Body: t Y ktr�� n i Aid rXL' Shoreland Agreement/SIPS Y/N: <br /> 9 ) , ` <br /> m Farmland Preservation Y,N: / Iy Managed Forestry Law Y <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: t^ <br /> PGI h bJ 1Q, Nr NUJ and 4h¢ A) 36 ` X So/ Cf&L I <br /> -Ex N Soo' 861 Acres: I . 554- 5q' 17-'5- <br /> (If <br /> q• '7S(If parcel is to be surveyed,provide preliminar map. See attached for preliminary map requirements.) <br /> Proposed access to public road: nalc / ac{ _e. AF- <br /> Proposed access to public waters to be provided Y/N: / <br /> If yes,describe access: — <br /> Signature of Owner: �r `y� '�� Date: <br /> C5 <br /> Signature of Owner. i;t1 �� Ct 'C��" �` /2".+G>p� Date: // - S. — �C:// ° <br /> o is <br /> fz <br /> ➢ Does parcel meet Zoning Requirements? o Qr t' �Ye LY <br /> I- lr-l( �j <br /> t_4 <br /> ➢ Does parcel require a Survey? Yes _ No -,) �— �6 <br /> e oz <br /> Permit application fees submitted? ❑ Amount S Receipt# <br /> Reconciles with Real Property Lister Yes No Date: I�LQI l r p <br /> � LLPool,ex Iain:. <br /> annd �n <br /> n Mj0i2i jo jAp o d / d Repson for Denial: <br /> N <br /> Land Use: Date: _ t <br /> BURNETT COUNTY b <br /> ��All\In <br />