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le m ' 1 <br />Owner:We- 1 C' AyJeYSO n Buyer:CIO <br />� <br />Address: S/ a I CL.�e_ kls Address: <br />S� wr 89oa w <br />Phone: Phone: <br />0 <br />Original Parcel Information fir, <br />Parcel ID #: Section 7 Township Range <br />0/,- 09 <br />Original Description (or.attach!`c�opp (o <br />or <br />Current Zoning: A—L—Floodplain Y/N: 1 Wetlands Y/N: 1 Lake/River Class: <br />,> Name of Water Body: Ct «L� !'� t �i1'� Shoreland Agreement/SIPS Y/N: M <br />b <br />9' Farmland Preservation Y/N: �J �� Managed Forestry Law Y/N: ��� t� ,5 <br />o � <br />T New Parcel Information <br />II S <br />Proposed New Legal Description and Parcel Size: < ` c Q & J �/L �'c �?0, <br />/'COAA 4Lti` d <br />Acres:— <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: 0cl <br />Proposed access to public waters to be provided Y/N: <br />If yes, describe access: z <br />S <br />Signature of Owner: C L!r-4i Date: /.� <br />Signature of Owner: Date: <br />➢ Does parcel meet Zoning Requirements? Yes No l� <br />N ➢ Does parcel require a Survey? Yes No <br />° <br />Permit application fees submitted? ❑ Amount $ Rece pt # <br />9,,Reconciles with Real Property Lister ,Yes No Date: <br />If not, explain: <br />a <br />n Applicatio Approv /�I enied Reason for Denial: <br />Land Use: ,/,_ ,, __e ���/a ©/Date: <br />Fees (must accompany form): <br />Burnett County Subdivision Permit Application <br />Subdivision w/o Survey: $50.00 <br />Survey of Existing Parcel: $50.00/lot <br />and/or Pre -Application Form or Map Review Form <br />Subdivision w/ Survev: $200.00 + $50.00/lot <br />le m ' 1 <br />Owner:We- 1 C' AyJeYSO n Buyer:CIO <br />� <br />Address: S/ a I CL.�e_ kls Address: <br />S� wr 89oa w <br />Phone: Phone: <br />0 <br />Original Parcel Information fir, <br />Parcel ID #: Section 7 Township Range <br />0/,- 09 <br />Original Description (or.attach!`c�opp (o <br />or <br />Current Zoning: A—L—Floodplain Y/N: 1 Wetlands Y/N: 1 Lake/River Class: <br />,> Name of Water Body: Ct «L� !'� t �i1'� Shoreland Agreement/SIPS Y/N: M <br />b <br />9' Farmland Preservation Y/N: �J �� Managed Forestry Law Y/N: ��� t� ,5 <br />o � <br />T New Parcel Information <br />II S <br />Proposed New Legal Description and Parcel Size: < ` c Q & J �/L �'c �?0, <br />/'COAA 4Lti` d <br />Acres:— <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: 0cl <br />Proposed access to public waters to be provided Y/N: <br />If yes, describe access: z <br />S <br />Signature of Owner: C L!r-4i Date: /.� <br />Signature of Owner: Date: <br />➢ Does parcel meet Zoning Requirements? Yes No l� <br />N ➢ Does parcel require a Survey? Yes No <br />° <br />Permit application fees submitted? ❑ Amount $ Rece pt # <br />9,,Reconciles with Real Property Lister ,Yes No Date: <br />If not, explain: <br />a <br />n Applicatio Approv /�I enied Reason for Denial: <br />Land Use: ,/,_ ,, __e ���/a ©/Date: <br />