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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-A plication Form or Map Review Form Subdivision w/Survey: $200.00+S50.00/lot <br /> elys, L a' .1/L. <br /> Owner: c+ _ ler rt : J.4 !IA/ r :uyer: _ *erns x."41 j <br /> Address: 0 2-0 <br /> �t ) 0C, -- Address: / 9,.c. ' �0 J ' <br /> frtAii tk,.. 02(21^. / j/Z a/ 5,00. <br /> L <br /> Phone: ---7(...5-°. s)-7 3 ., -`5"??-2z Phone: 7/ 7-7tt3J /YO? O <br /> 07_ (S- Original Parcel Information <br /> Parcel ID#: er?'3 ..- Up 0--D//000 Section /3 Township 3?) Range/ 6 <br /> Original Description (or attach copy): �ec tom. --5-0-a. c. p <br /> Current Zoning: --4 t--- <br /> s)/ Floodplain Y Wetlands Y Lake/River Class: J11/// (-- <br /> / v <br /> Name of Water Body: /)14 Shoreland Agreement/SIPS 117' <br /> / <br /> t ;. <br /> ' Farmland Preservation Y/ 1 Managed Forestry Law Yom: _, , <br /> New Parcel Information / !� o <br /> Proposed New Legal Description and Parcel Size: e -Z(4-i .�% c <br /> I ,,k- ... t Vd--OvV earc-e-( , ► z/z- -It 414,30"7 6 a. <br /> Acres: � — a c{'�---'' <br /> Ifparcel is to be surveyed, 00 <br /> ��'S? �e,�> <br /> ( y ,provide reliminary ma a^tta��ed for pr: *minary map requirements.) <br /> &�tf a(-1,424, t/ <br /> Proposed access to public road Y _ 4, 'um , .- r.` v C.4 <br /> •, 0 ' - ' <br /> r....-r L-e--( <br /> Proposed access to public waters to be provided Y <br /> l ',,If yes, describe access: <br /> Signat�� e of O'ejra <br /> - - . If Date: r//1,��� �.� is <br /> fritSignature of Owner: t.-•0 J ` I .Date: , <br /> ➢ Does parcel meet Zoning Requirements? Yes No1)4 <br /> c > Does parcel require a Survey? Yes No <br /> 70 <br /> Permit application fees submitted? 0 Amount$ 5C/-- Receipt# 3032 <br /> \ <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> Q <br /> If not,explain: li IE OE 8v �i <br /> E. <br /> e„ <br /> 0 <br /> n <br /> c Applicatio . Approved / De•ied Reason for Denial: AUG 2 5 2020 1 J <br /> Land Use: 61►.0 14 pt i 719 be. dei4 Date: <br /> 'ter)/ a: 2-oZ7 e.a A•f'.4s/0/ S Qr:y t�• =umett aunty <br /> Land Services Department <br /> v g Z? Zig ZOO <br /> / <br />