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M <br />Burnett County Subdivision Permit Application <br />and/or Pre -Application Form or Map Review Form <br />George & Joyce Benson <br />Owner: Buyer: <br />Address: 11271 Jacana Court #1706 Address: <br />Fort Meyers, FL 33908 <br />Phone: <br />Phone: <br />Fees (must accompany form): <br />Subdivision w/o Survey: $50.00 <br />Survey of Existing Parcel: $50.00/lot <br />Subdivision w/ Survev: 8200.00 + P,50.O0/lot <br />F;71 <br />Original Parcel Information <br />Parcel ID #: 014220410600 Section 4 Township 39 Range 15 <br />Original Description (or attach copy): Parcel described in Warranty Deeds record as <br />Document No. 446983. <br />Current Zoning: RR -1 Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: N/A <br />Name of Water Body: Warner Lake Shoreland Agreement/SIPS Y/N: N <br />Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: We are submitting a new CSM that <br />will cover the description to a CSM description instead of the existing metes <br />& bounds based on a unrecorded plat. 0.33± <br />Acres: <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: Existing access = Gatten Point Road runs north to Warner Lake Rd. <br />Proposed access to public waters to be provided Y/N: N <br />If yes, describe access: <br />Signature of Owner: <br />signature of towner: <br />N <br />➢ Does parcel meet Zoning Requirements? <br />N ➢ Does parcel require a Survey? <br />0 <br />Permit application fees submitted? ❑ <br />❑ Reconciles with Real Property Lister <br />If not, explain: <br />a <br />Yes No <br />Yes No <br />oa <br />Amount $ <br />Yes No Date: <br />0 <br />Q Applicatio Ap roved�niedeason for Den <br />Land Use: f <br />ZQl(�' Date: <br />Date: <br />nate: <br />Aw <br />keL ►f48'T1, <br />Receipt # <br />