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Fees (must accompany forni): <br />Burnett County Subdivision Permit Application Subdivision wtoSurvey: $50.00 <br />Survey of Existing Parcel: $50.00/lot <br />and/or Pre -Application Form Subdivision w/Survey: $200.00+$50,00/lot <br />Owner: 'DiQYlct 1kh.,I ICcs' <br />Address: MUD QJ J 3S <br />Phone: <br />Buyer: MOY (AY— 7N,\2 <br />_ <br />Address: -7LD' l )S Rj <br />Phone:�1 ��� a �0�'- � (S S l <br />Original Parcel Information <br />07-�icC-Z-yt?-ltc-Ck'-.3 �N-o�0 u��o��1 <br />Parcel ID #: 07 QZO- 2 -y0 ) 89 3-cs3` <br />0(3 ..Cl wr= Section Q Township i4o Range <br />Original Description (or attach copy): S\ 1 X\A -tF)! P2T LYG W AN, �e_ �G <br />3S G—,X 1+WY It 3900'41, -t SF S VJ CX(- E C� <br />oiA <br />Current Zoning: A2 Floodplain Y/0—Wetlands 16)—_Lake/River Class: <br />Name of Nater Body: Shoreland Agreement/SIPS YG <br />Farmland Preservation Y� Managed Forestry Law Y&— <br />New Parcel Information C <br />Proposed New Legal Description and Parcel Size: a 10t 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: e— S 4 N v <br />Proposed access to public waters to be provided Y N• <br />If yes, describe access: -- <br />3� <br />Signature of Owner: X--� <br />rx A 'z <br />Date: <br />Signature of Owner: <br />Date: <br />➢ Does parcel meet Zoning Requirements? <br />Yes No <br />e L Z t'v Ig <br />c <br />D(opp 3 g <br />A Does parcel require a Survey? <br />Yes No o c� j Q N <br />Permit application fees submitted? ❑ <br />Amount $ <br />Receipt # <br />t. <br />Q Reconciles with Real Property Lister Yes <br />No Date: <br />I� <br />a <br />a <br />If not, explain: <br />n <br />0 <br />a <br />Application Approved / enied Reason for Denial: <br />Land Use: <br />3� <br />