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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> and/or Pre-A lication Form Survey of Existing Parcel: $50.00/lot <br /> PP Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner: �v a a �Rz. . X.21itu$1.41-1 Buyer: lCNr98L.tis;. <br /> m <br /> Address: 113 P Z,ily /,,,%t.i) e� Address: d 1 <br /> I 3 i a CtPi.irtil;';7 R-.rit) t) -i� <br /> CJ"l=-. %.t'P5 j a,1tj , veli 54-641.- 92.4n1 i-x`t aui 11i i C4-8 © <br /> Phone: Phone: •?i c .94'9- Cc 2 00 <br /> Original Parcel Information <br /> Illif <br /> c7'i ap'Z-Z'36. a s—3 ci•occ, -cid c c <br /> Parcel ID#: 0_v42..z.4$„0.?,,1:5_,3 04.-0 cc- .tit d0ec Section `i Township 36 Range d8 <br /> Original Description(or attach co 4 <br /> Py): � :Or-i a <br /> eD <br /> .;T <br /> Current Zoning: Floodplain Y/N: IJ Wetlands Y/N: "j Lake/River Class: <br /> F.; <br /> Name of Water Body: Shoreland Agreement/SIPS YIN: ki <br /> t Farmland Preservation YIN: <br /> sl Managed Forestry Law Y/N: h,i <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: &a- i h+t\AJ �4.%�l \ S <br /> Acres: 13,?9 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Cvr,ii ,44, p <br /> w <br /> Proposed access to public waters to be provided Y/N: t,;1 <br /> If yes, describe access: <br /> Signature of Owner: ,'J,; J ; ,, ,�,---- Date: . 'I y- Zt2 <br /> i _ <br /> Signature of Owner: i���� 7::_j_11./4 <br /> i �/LGYC�v() <br /> Date: 5'1�( — E-0 <br /> > Does parcel meet Zoning Requirements? Yes No <br /> E > Does parcel require a Survey? Yes No <br /> o <br /> ti <br /> Permit application fees submitted? ❑ Amount$ 2S�- ---- Receipt# <br /> [Si Reconciles with Real Property Lister es No Date: (o� oj <br /> ° <br /> 0 <br /> °' If not,explain: <br /> ° <br /> e. <br /> c <br /> civ <br /> v, <br /> Application Approved /,Denied Reason for Denial: NI <br /> CIO <br /> Land Use: 7 62f� Date: <br />