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Fees (must accompany form): <br />Burnett County Subdivision Permit Application Subdivision etloSurvey: $50.00 <br />and/or Pre -Application Form Survey of Existing Parcel: 050.0+{lot <br />Subdivision w%Survcv: $200.00+S;50.00/lot <br />Owner: Whitmore Birch Island Timber LLC <br />Address:3237 Summer Wind Lane <br />Highlands Ranch, CO 80129 <br />Phone: 303-888-3526 <br />Buyer: <br />Address: <br />Phone: <br />Original Parcel information <br />Parcel ID #: 07-028-2-40-14-18-5 05-006-011000 Section 18 Township 40N Range 14W <br />Original Description (or attach copy): PCL Gov Lots 6 & 7 Desc in 513/624 (PCL 2 D-1163) <br />(MFL Closed) <br />*Changes to tax parcels pending* <br />Current Zoning: rloodplain Y/N: Y Wetlands Y/N: N Lake/River Class: <br />Name of Water Body: Birch Island Lake Shoreland Agreement/SIPS Y/N: <br />Farmland Preservation Y/N: Managed Forestry Law Y/N: Y <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: New 1 Lot CSM <br />Acres: 2.0 <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/N: <br />If yes, describe access: <br />Signature of Owner: f _ Date: %% g <br />t <br />Signature of Owner: Date: <br />➢ Does parcel meet Zoning RequiremeWS? Yes No <br />➢ Does parcel require a Survey? Yes No <br />➢ Permit application fees sit bin itted? ❑ Amount S.2-5. ..`...__ . Receipt #&-5116 <br />❑ Reconciles with Real Property Lister Yes No Date: j— C <br />If not, explain: <br />Application -,eApprovedI Denied Reason for Denial: <br />Land Use: <br />1 Z-%11 I Date: <br />..Q <br />11 <br />0 <br />3 <br />c <br />n <br />��:g1 <br />V1 <br />