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Authentisign(D:C66C9064-C3B847A7.80A7-7A027CFCF44A Fees(must accompany torm); <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+$50,00/lot <br /> Owner: / "(Q-A CM) /5/ !lel f Buyer: 7h f�l�t`' Lj1� 4 <br /> id <br /> / � n <br /> Address: [AlW 7 d 115 /d Address: 56,6 g ),t,Yc g <br /> /4r kat 5414 L L G 4.77 ,(/f P___di Air- 5'.597 a-- <br /> 0 <br /> Phone: j /j - .l -- 1 7 `.1f -- Phone: /7 I ‘f - "I 2 / 7) y /3 •zb <br /> k) <br /> nix IO 4555 Original Parcel Information rti <br /> Parcel ID#: o70/lig 3 8/5d 75o/a D/34OOSection 7 Township 3 0 p Range /5 t <br /> Original Description(or attach copy): g <br /> 0 <br /> b'o0 Lo `f- l A rx 1/2- i z "d W lb- 1z <br /> is 5 <br /> ,..4.k.o <br /> la Current Zoning: ,4zj a• /W1ifliioodplain Y/6) Wetlands YO1 <br /> Lake/River Classification: .r' Name of Water Body: <br /> Shoreland Agreemt or SIPS Ytk Farmland Preservation Y,6 " Managed Forestry Law Ye 0) <br /> New Parcel Informationntelt- <br /> Proposed New Legal Description and Parcel Size: t l/2- IA) /l Z /76Vf- ` d <br /> (rvner r--0-4-7-4��m y J r/_ wiz ba v /zit- - <br /> Acres: / a <br /> (If parcel is to be surveyed,provide r6 <br /> preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 4. d <br /> rr m <br /> Proposed access to public waters to be provided Yl <br /> If ves,describe access: k-:- <br /> 01/19/2022 <br /> Signature of Ownecalait424- <br /> Date: <br /> N <br /> Signature of Owner: • ' Date: c <br /> -�E <br /> N <br /> > Does parcel meet Zoning Requirements? Yes No <br /> litliLULT--- 1 \ El <br /> e1 7 <br /> a. ➢ Does parcel require a Survey? Yes No JAN 2 0 ' <br /> 2 <br /> > Permit application fees submitted? 0 Amount$ 1 -- 'e ='pt# J 1 <br /> 1 <br /> d — Bo.+ett C1run[y <br /> t ®Reconciles with Real Property Lister No Date: zs 2 Land Services Deja t <br /> 0. <br /> ril If not,explain: . <br /> r7 <br /> 0 <br /> . <br /> 0 <br /> H • <br /> Applicatio Approved / enied Reason for Denial: <br /> Land Use:yir..cc..__ /72✓/w 2 2—Date: <br />