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Fees (must accompany foie): <br />Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br />and/or Pre -Application Form <br />Survey sionof w Survey: <br />S 00.00/lot <br />Subdivision w/ S�wev: $200.00 + $50.00/lot <br />Owner: .LJ iGtyAck lk1 tAj inn Buyer: ty 6naV-61 �PC"y' _ <br />Address: a g a-] Q)j6S j? Address: -LD '�X 0-S <br />Phone: Phone: l Ic 1 ��' 1 <br />Original Parcel Information <br />07-02.C-2-10-4-cf.3 Cl/ -000 c,iool <br />Parcel ID #: O7 e20- 2-y0•idaB9 3- FI. 000.-C,11 too- Section—_Qi Township 140 t <br />Range t_ <br />Original Description (or attach copy): _ S\jl SU LEX PET L.YG VJ 4 An le_ VG <br />3S C --X I+Wy Bast. ' 39r'a-Q -�,- SIC S \A/ 6XC E C� <br />01A I�w l_'V� <br />Current Zoning: A2, Floodplain Y10 -Wetlands I6)_Lake/River Class <br />Name of Water Body: <br />Shoreland Agreement/SIPS Y <br />Farmland Preservation YAO Managed Forestry Law Y, <br />New Parcel Information c <br />Proposed New Legal Description and Parcel Size: a ) U+ CSM <br />Acres: 39, _?/ <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: X S 4 y-\p� <br />Proposed access to public waters to be provided <br />If yes, describe access: <br />Signature of Owner: r L— Date: <br />Signature of Owner: Date: p <br />➢ Does parcel meet Zoning Requirements? Yes No /t' e c, <br />➢ Does parcel require a Survey? Yes No <br />Permit application fees submitted? ❑ Amount $©� Receipt # <br />r. [g Reconciles with Real Property Lister Yes No Date: I I, <br />a <br />C' If not, explain: <br />0 <br />a. <br />y <br />Applicatio Approved /),Denied Reason for Denial: <br />Land Use: /� 30 20 Date: <br />-1 <br />d <br />y <br />rt <br />W <br />rb <br />°O <br />n <br />O <br />.P <br />"O <br />C <br />