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i <br /> 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 or Map Review Form Subdivision w/Survey: S200.00+$50.00/lot <br /> b <br /> l z et <br /> ea i. <br /> Owner: �all I.l t � o' �CG 1'1 Cr�AG•tT Buyer: <br /> n \ G <br /> Address: 22(2-Z- Jo 1C..d Address:�nr\Svr� - o <br /> Fre.A1 &r►C. L.3 i 5LI ET7 <br /> '?51- 6`f7-6 0/ / W <br /> Phone: Phone: <br /> / Original Parcel Information Ijc <br /> Tax ID#: /0I q2- Section 35. Township 2Range /5 <br /> Original Description(or attach copy): ,Lk- rki, ci <br /> O <br /> 4 <br /> a <br /> A <br /> I <br /> Current Zoning: '` -1 Floodplain Y/N: Ye Wetlands Y/N: WO Lake/River Class. <br /> 11 <br /> Name of Water Body <br /> : 5PCI1 LP// LA �t-� Shoreland Agreement/SIPS Y/N: D <br /> Farmland Preservation Y/N: do Managed Forestry Law Y/N: /V'O <br /> New Parcel Informationi5 <br /> M <br /> Proposed New Legal Description and Parcel Size: deLAI Cs/'! <br /> Acres: 570V <br /> f" b <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) y <br /> Proposed access to public road: By easewie4 1 r e C-cJ rci d al IN ec f 11 .; <br /> Proposed access to public waters to be provided Y/N: f�Q <br /> If yes,describe access: <br /> Po <br /> Signature of Owner: -e►�� S.6-ei�n�-%--,° Date: cQ/r 7 k 3 <br /> Signature of Owne •__ yC4��� —d'e ' �' N Date: // 7/ 3 <br /> > Does parcel meet Zoning Requirements? Yes No = Fee Rec: -�bt Or i Check#: 2/D8' <br /> u, <br /> > Does parcel require a Survey? Yes No u <br /> r <br /> D <br /> Z CDO <br /> m r <br /> Reconciles with Real Property Lister CED No Date: 2-.29-QS n a Inill <br /> -Ti 0If not,explain: Z.3 <br /> > 5 Co <br /> gi) <br /> ' O <br /> Applicatio Denied Reason for Denial: : 3 c ^� <br /> Land Use: Date: u u!, <br /> y/otra3 C:=f) <br />