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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: S200.00+S50.00/1ot <br />Owner: I-cxcvy -i' Co.( -OI e0_ -Q5 k Buyer: <br />Address: .'S`t'.30 M ( v m0c,J �-Je M. Address: <br />Phone: 2/S— 2-6, G, ggty/ Phone: <br />a�-oao_,tyou-/b-ol-;? 0a-c)w--0atc_K-_0rij!inal Parcel Information <br />OR -600-0)-700-0 <br />Parcel 1D #: CZ -2 - OCX�-0, Section Townshi O Range <br />Original Description (or attach copy): PC 1 L /!�Ig 'o('Ll /y �10P G V qiI Pc?', 4 - <br />Current Zoning: a Floodplai4iY,V: Wetlands lY:_ Lake Iver Class: <br />�� q2 <br />m Name of Water Body: Cr w I L P _ ��0WOLJ Shoreland Agreement/SIPS Vi N <br />0 <br />Farmland Preservation /N: Managed Forestry Law YCN- <br />New Parcel Information V, �� [' -A0q__�11 (Al <br />Proposed New Legal Description and Parcel Size: 'V e t") /-t' t© � C 6 YVl <br />Acres: ) ('j, 0 7 <br />(if parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: <br />Proposed access to public waters to be provided YIN: <br />If yes, describe access: <br />Signature of Owner: <br />Date: <br />Signature of Owner: J� Z- AllM44 J Date: <br />> Does parcel meet Zoning Requirements? Yes .No <br />> Does parcel require a Survey? <br />Permit application fees submitted? <br />Yes No <br />Amount $ QT) Receipt # <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />Applicatio Approved / 'nied Reason for Denial: 2017 <br />'V <br />Land Use: Date:ZOIING <br />in <br />T <br />W <br />