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Burnett County Subdivision Permit Application <br />Fees (must accompany form): <br />Subdivision ,vloSurvey: $50.00 <br />and/or Pre -Application Form <br />Survcy of Existing Parcel: $50.00Aot <br />Subdivision wl Survey: $200.00+S50.0011ot <br />Owner: �. DuYXta4 Buyer: <br />JGotf <br />di <br />ROUCS/Aol <br />t��%� <br />/ <br />Address: 9f 9 Ccdt+" &c Address: <br />5,39 <br />it f4.4� u• <br />51 <br />%/A r iY 'r+r.. Lk. I)IA. S -we. <br />5,44 <br />S 1 P4 t'l Mm. 37S'o7S <br />Q <br />Phone: _ -- Phnne: <br />�i'sj- 23F -7/Z2 <br />E <br />Original Parcel Information <br />b7.ota-2-4olf�•27-r±'DS-pCkQ t}IiI�Q <br />Parcel ID #: p `8jloolSection 2? Township'�1 D Range 14 <br />Original Description (or attach copy): PC C.SM U ZS ~ pfl4 <br />Is 7!2 <br />Current Zoning: IM Floodpla4&-. SYetland*'Vyi: LakelRiver Class: <br />Name of Water Body: _. Al wg4 4 4, $A r_11 k,4Q4}« Shoreland AgreementlSIPS'YIN; <br />Farmland Preservation Y4 Managed Forestry Law <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: )V cw C S 1h <br />b<hn« c5^ Gast, l.f G►A., �`. vf, <br />tMaj Ltrr1 fit .t <br />Acres: 4.0t* - <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: G <br />Proposed access to public waters to be provided YfN: C&A -1 -As <br />If yes, describe access: <br />Signature of Owner: <br />Signature of Owner: <br />Date: <br />Date: 2 Zze <br />> Doesparcel meet Zoning Requirements? Yes No ( 'L9 l q <br />> Does parcel require a Survey? Yes NO '4t� W_ %g $al <br />S p0 <br />i Permit applicationffees submitted? O Amount $ Z J 0 ' � Receipt # <br />© Reconciles with Real Property Lister Yes No Date: <br />a <br />If not, explain: <br />n <br />a <br />c <br />m <br />Application: -Approved ! enied Reason for Denial: <br />Land <br />Date: <br />