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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+550.00/lot <br /> Owner: AI(-CAI 4 u"Xi-7 f,.&I Buyer: ;g27itr 4' —1'/i?.?-t3' A/✓ '2.Se k/ ti <br /> it <br /> Address: JO 5 2C CL1301,41 /s,l4-C iZck.) Address: (c o-3 �4/ ,:ic✓ LAro: /4 g <br /> An- /3ui�c kl/ 3 4v �`�%.i ik/ �t '5",/ -7z-. <br /> z <br /> 1'4-4 / (?'s Z Zv i 17 L/ $412.9-Ft G <br /> Phone: Phone: C7'7 J 'g 26- 3�'7 /3t`iv W <br /> Original Parcel Information 41, <br /> 6'4 <br /> Parcel ID#: 07-vo6. Z-Jig-ii 32.Z ©/'et0••O/'oOc^Section ?L Township Sts' Range j'i- C <br /> Original Description(or attach copy): til Cr NW <br /> CD <br /> -s <br /> CA A7- <br /> Current Zoning: A2 Floodplain Y/N: Al Wetlands Y/N: Al Lake/River Class: Alli- <br /> -0 <br /> fi <br /> AD Name of Water Body: NA--- Shoreland Agreement/SIPS Y/N: Al <br /> E <br /> Farmland Preservation Y/N: /4 Managed Forestry Law Y/N: AJ <br /> New Parcel Information I_ <br /> Proposed New Legal Description and Parcel Size: 1-c r I• Al ciAl G5M <br /> CI <br /> ) <br /> Acres: 5.0C) <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: a t3 yj L,/.14Z- j2.04-p d <br /> Proposed access to public waters to be provided Y/N: /y ..i <br /> If yes,describe access: <br /> 7y 7 / 0 <br /> , <br /> Signature of Owner: ,, .:, �� ;/�-a- -- Dater" i <br /> n <br /> Signature of Owner: Date: 3 <br /> b <br /> ➢ Does parcel meet Zoning Requirements? Yes No I3 .?1 F <br /> 0 Does parcel require a Survey? Yes No <br /> S0 <br /> 0° > Permit application fees submitted? ❑ Amount$ ? r 0----- Receipt# <br /> F <br /> C„ <br /> 61 Reconciles with Real Property Lister Yes No Date: \C)-n-ao <br /> to <br /> 0 <br /> o. if not,explain: <br /> .7-F <br /> 0 <br /> a <br /> w. <br /> Application: • pprove((' Denied Reason for Denial: <br /> (05th; 1 e5 <br /> t,, ,' ' ettc/o poc4n--/— prol/JSi or <br /> Land Use: / L/c^^- J//Z®ZD Date: <br />