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Authentisign ID:'711168CC-2FE2-EE11-85FB-6045BDA755EQ <br /> Fees(must accompany form): <br /> Burnett County Subdivision Permit Application . Subdivision w/o Survey: $50,00 <br /> Survey of Existing Parcel: $50A0/tot <br /> and/or Pre-Application Form or Map Review.Form Subdivision tv/Survey: $200.00+$50.00/lot <br /> Owner: bL f e �k...,A1 y' e_ C r\6 Buyer: el i <br /> le <br /> Address::t OQ tC)...1�!)OY Duch W2dress: ..' p <br /> Apt 3 o mpLs , tug % ,4'63 <br /> phone: G- l3 0 - JU v 5 Phone: F V <br /> Original Parcel Informations l `- / 't Of) <br /> Tax ID#: 1 18 5 s Section Township 3 Range tS 1N <br /> Original Description(or attach copy): K\C Nt i <br /> L <br /> s t <br /> 0 <br /> Current Zoning:Q(�:RR Floodplain Y/N: 1�.t Wetlands Y/N: Ilitis Lake/River Class: <br /> Name of Water Body: Shoreland Agreement/SIPS YIN: t. w <br /> NJ i <br /> Farmland Preservation Y/N: �,•,� Managed Forestry Law Y/N: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: £'.f) P c C\e C L. - O_ <br /> '.\J 'L& \INria Iv f N E 1 Eta, Attil 'ea lJ r, ) 1 <br /> 1)-a. Etig N.)E F`. y ,Ia. E, NE Nt'Acrea: L( CYQ CO \ <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: L.0e,,'S is <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: v <br /> At thent+�[c j ; : Joyce Louise Cuhdy st 03/14/24 <br /> ➢ Does parcel meet Zoning Requirements? Yes No Fee Rom:Check <br /> L <br /> Check#:_ <br /> D. Does parcel require a Survey? Yes No <br /> Reconciles with Real Property Lister Yes No Date: /1 q f d20'2- ` <br /> 6— iflrli <br /> If not,explain n 3 <br /> o ca -... [IA <br /> Application roved led Reason for Denial-. v o crs o <br /> a • N 2 <br /> Land Usti.). _ -_ Date: �' N.., v <br /> 3 7t-4 -' 2©�ZoZf Ind <br /> LL-- <br />