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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or Pre—Application Form Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner: j ; <br /> . t;,'c>, 1 d - L, ea (7),1-0:1‘1_Buyer: ,/ P ,--,i� .) -o <br /> Address: ,,,QS'-',Q 7 7 /77c Zi/j Z, e "C al_ Address: GLt 2, e <br /> ��pc� c,,1G /3 _ L.7-6/ .< 9c->c.>i7--E ,- 1-,..: - . EC / o <br /> Phone: 7/'3- to Jf.D---7 tiO/ Phone: -7 /_-I2-;' J/ // "2 tf3 <br /> Original Parcel Information 0 <br /> Parcel ID#: / 9J,,,2 7 Section ,_.- Township L/C? Range /e/ 4 <br /> O <br /> Original Description(or attach copy): ----:- //9 G,,) <br /> eton <br /> .o Current Zoning•4=9--- Floodplain Y/N: •�` Wetlands Y/N Lake/River Cla s: /4)/t- <br /> o• Name of Water Body: t,/i i -�1 Gt n cel Shoreland Agreement/SIPS Y/N; /� <br /> Farmland Preservation Y/N: /V Managed Forestry Law YIN: /r <br /> New Parcel Information <br /> O <br /> Proposed New Legal Description and Parcel Size: C.F (,-( In) - CU gC <br /> c.K23 - 410 -/y <br /> IN- <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: L.-1y ,Cj/ p <br /> e <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> N� <br /> Signature of Owner: G`�?��.cL�f' `DGh k Date: �/ /2.-e72 ,7 V <br /> Signature of Owner: —�', ___-4.____ J. /y p7 a-1 Date: 5 - (T _,..,;26,:2 C <br /> C <br /> Does parcel meet Zoning Requirements? Yes No ;ii II& <br /> N 1''r :T ri 1 2023 4,11 <br /> ©= .> Does parcel require a Survey? Yes No s <br /> E. oQ <br /> cre, Permit application fees submitted? ❑ Amount$ 5040 Receipt# C PIP „C. <br /> P <br /> r., 0 Reconciles with Real Property Lister Yes No Date: <br /> o <br /> a <br /> °. If not,explain: <br /> A <br /> © <br /> -s <br /> F., <br /> Application: Approved / Denied Reason for De ial: Si, <br /> 64�ess fz' (.as�- Pe/717 4 Gave be- -Emilt4e, Ao�'/�i ry <br /> Land Use: 9-id‘i- te _ .57/2020 Date: <br />