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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50,00 <br /> Survey of Existing Parcel: 550.00/lot <br /> and/or Pre-Application Form Subdivision w/Survey: 5200.0©+550.00/lot <br /> Owner:D 1 A 14 + 1Y1taayr G l A74?m er4"gA •: —"Ma"(a"( h 1. <br /> Address: 337 a k S,rAv ./...r, Address:riL�1 't V�e001.0:4515,' 1 <br /> A1b0,l/ i ii -c&S7 --V\I'C14LS 'jiIAk 54 3 P <br /> Phone: 50745- Gi <br /> >-� c7,� Phone: _ 1 J - " g(1=c9(.S G <br /> 01-t1i -a-.4c,-i',--it••t •1` -1.)3' a a i <br /> t)r�asnal I�areei information <br /> c>7-c3tZ-1 -Ya -iS-r1-5- 4sZ757.4:>8l ' i <br /> Parcel ID#:,, _„ - , - -. - -..4%., Section I 1 Township 4) Range f_S— <br /> Original Description(or attach copy): -}5 7/ -4- 7 a -7411 Maotl CI—RC—Lc' <br /> 14 {\��.11 V,(( s }C So ft 1,i,,rY S}„ 3 <br /> U <br /> 1• f <br /> Current Zoning: Pt)D Floodplain Y(9 N V Wetlands Ye IV Lake/River Class: (1 <br /> Name of Water Body: N�A Shoreland Agreement/SIPS YIN: <br /> Farmland Preservation Y/N: rrN Managed Forestry Law YIN: J , <br /> New Parcel Information el-i,Ay" <br /> L. 1 ebn� - Le <br /> 1 <br /> ze: <br /> 1..�3 <br /> Proposed New Legal Description and Parcel Si <br /> 54 iu Acres: 1 • '5-3 <br /> (If-parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: "� <br /> If yes,describe access: /, 4.4J+ t 10 f 7• I/2 z/Z' :'*9 <br /> Signature of Owner: a.„,7„.„4,4,11.,„/S-"4 2; Date: ? /Y--D,. Q` <br /> ,/ ' n <br /> Signature of Owner: U -s, //r _-:.,t_. - _„,....4!„,.."46.,,,,, Date: er-i?-Qo„ge, <br /> > Does parcel meet Zoning Requirements? Yes No •�.• CiLL q <br /> ��'-= v1� (oO 2-38- <br /> c > Does parcel require a Survey? Yes No <br /> 0�1 <br /> tii > Permit application fees submitted? 0 Amount$ ) `� ' 0Receipt Y a‘Ui <br /> Vi <br /> r ®Reconciles with Real Property Lister CD No Date: GI-29-2.c N <br /> 011 <br /> If not,explain: of <br /> n <br /> a M <br /> 3 <br /> Application: pproved enied Reason for Denial: <br /> n <br /> � 12= <br /> �I S- <br /> Land Use: 4 /D7y ZOZO Date: J �� 1 5 2020 <br /> Burnett County <br /> Land Services Department <br />