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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+$50.00/lot <br /> Owner: Scott Augustine Buyer: <br /> b <br /> CD <br /> Address:2330 E Villa Real Dr Address: <br /> Orange CA 92867 p <br /> s <br /> 626-705-5981 <br /> Phone: Phone: <br /> POOriginal Parcel Information ‘ <br /> Parcel ID#: 07-032-2-41-16-13-5 15-044-017000 13 41N 16W <br /> Section Township Range <br /> O <br /> Original Description(or attach copy): Bass Lake Assessors Plat Lot 7 4 <br /> a <br /> a <br /> n <br /> .o Current Zoning: RR2 Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: <br /> o Name of Water Body: Bass Lake Shoreland Agreement/SIPS Y/N; <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N:N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM divide existing lots <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: t7 <br /> a <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: / II �, <br /> t......, <br /> Signature of Owner: _IFNARIEUNI_ Date: <br /> Signature of Owner: PAII MIa ate: c <br /> ➢ Does parcel meet Zonin• �, i• �'I' No 4,P 60 1l 5 <br /> o ➢ Does parcel require a uey? ' vo Ct 1 ( °SYS— <br /> w <br /> 0 a' toy.] 4200.e0.2 <br /> Permit application fees submitted? ❑ Amount$4.0s44-529' Receip <br /> t., ❑Reconciles with Real Property Lister Yes No Date: '10 <br /> ' <br /> a <br /> a , <br /> a. If not,explain: <br /> W <br /> kyi <br /> Application: Approved. Denied Reason for Denial: <br /> G 0/4s eeef- c v W 7€- / wIC/ - <br /> Land Use: .3///zoz 2— Date: <br />