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i <br />Fees (nmst 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: $200.00+$50.00/lot <br />y,gv Skx se. LLL <br />Owner: lb, cing- are_ T,,pl�e -1 bocci Buyer: <br />Address: Z4 250 1Q; q Sand LA Vt_ Df Address: <br />WL 54 89 3 <br />Phone: lau5l NO - 0-15 1 Phone: <br />Original Parcel Information <br />o7 -o2&,2-39-15.32.5 os -009. 025010 <br />Parcel ID #: 01-021n 2-3cj- 15-32-S 05- oOS- 6-411 "Section 32, Township 3c% Range / r <br />Original Descriptions (or attach copy): L'okS Z '1" 3 �t``I V -7i-, i> <br />Current Zoning: RR 1 Floodplain Y,L_wetlands Y/�-Lake/River Class: <br />Name of Nater Body: _ Shoreland Agreement/SIPS Y/N: <br />Farmland Preservation Y/L1 Managed Forestry Law Y/ <br />New Parcel Information i <br />Proposed New Legal Description and Parcel Size: 1 Lok Cort 1 a S krv-, <br />Vla,o -1L (j)Y-nb'%ra _ IONS 2 CSN V 20 P I7� <br />Acres: '7.3I <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 Y/v: <br />If yes, describe access: <br />;- <br />cam, <br />Signature of Owner: <br />Date: 1013�►?� <br />Signature of Owner: <br />Date: <br />Does parcel meet Zoning Requirements? <br />Yes <br />No <br />N <br />> Does parcel require a Survey? <br />Yes <br />No C,4-- A- /S'6 7 Z__ <br />P' <br />PO <br />> Permit application fees submitted? ❑ <br />Amount $ <br />,a <br />Receipt # <br />�. <br />❑ Reconciles with Real Property Lister Yes <br />No <br />Date: <br />m <br />If not, explain: <br />n <br />0 <br />a <br />Applicati : L Approved`/. Denied Reason for Denial: <br />Land Use: _ �� �� <br />�� <br />Date: <br />;- <br />cam, <br />