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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: $50.00/lot <br /> and/or Pre-Application Form Subdivision w/Survey: 5200.00+550.00/lot <br /> �41c?lind�.. liD ,�,( 1�,�a,n(�� r <br /> Owner: `" 'r Ue ' :Sr Buyer: C I-en h A. 'CSG` k€v\ b <br /> tt ` fD <br /> 12 <br /> Address: 732 J PM NW Address: c- .1i 2- Co r b+ +� Rot <br /> 0 <br /> i. <br /> w;l.ov �Z N � 3�� iN e�s� V\11 sal 3 : <br /> / Qail f �, 2O3' 9 C� <br /> Phone: ���' (_I �T�"/�'� Phone: �D��� -'� tp <br /> N <br /> plf.3oo <br /> .7..L.. ) Original Parcel Information <br /> ....IParcel ID#: c j SOo /V q4 S'S" OG C 3 1-4-•d Section Z Township 37 Range /S 60 <br /> Original Description(or attach copy): C t.A-rt.a f / e$,14 ' 4 003 ? Tic /4477f <br /> ro <br /> 7 C.erf ,c-Be-r- op c- Scpc4ry 370.oS +•T op G. L. f <br /> t NW -Ng Gkder 'T Ahrvr 400 c%0-40-re oF ^,/1. /-.slc <br /> t <br /> .0 Current Zoning:(gla\ Floodplain Y/N: Y Wetlands Y/N: V Lake/River Class: P <br /> a Name of Water Body: Ant 1.-40.4r3 La4CV---- Shoreland Agreement/SIPS Y/N: A p. <br /> / <br /> � <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: , <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> 4-07_ I ': 0Ler Lee - I o, - <br /> tA' �Ste- — l7 a-4w— .fl-7,-.4ciax0 zG'c.s"1 . <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 020,...,Tlit/6,- ( / »-ua�`� C <br /> Proposed access to public waters to be provided Y/N: ". n <br /> 4 <br /> If yes,describe access: <br /> Signature of Owner: [YlJ2..L /i. ta ._ T9-L-� Date: 5 2`-I / Z N <br /> Signature of Owner: t Date: .s zi- ( 'Z' B <br /> C <br /> i Does parcel meet Zoning Requirements? Yes No - /6 Z--3. <br /> Ni <br /> i= Does parcel require a Sumer? Yes No <br /> Vt <br /> _ 2 00 <br /> 00 � Permit application fees submitted? 0 Amount$ 300• Receipt# CI <br /> ® Reconciles with Real Property Lister No Date: (o/30/a( rt <br /> a <br /> 0. If not,explain: <br /> -n}- <br /> n <br /> C U�+ <br /> n <br /> _ 00 <br /> Applicata• Approved / i enied Reason for Denial: <br /> Land Use: l 7 /G ave, Date: <br />