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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application SubdivisionwoSurvey: $50.00 <br /> Survey of Existing Parcel: S50.00,lot <br /> and/or Pre-Application Form or Map Review Form Subdivision w'Survey: S200.00+$50.00/lot <br /> rr� <br /> Owner: t✓ ...our 1TAirte- L.C.. Buyer: 3 <br /> p <br /> Address: 13 7/e Jc, ,/nr,$544 S�.i� .6� Idress: o <br /> t) <br /> ALitreflfw, i L.0 e&6,<2 ooc F <br /> Phone: y "J `' / 47l Phone: <br /> / Original Parcel Information <br /> Tax ID#: ,...3Z O- �Section 6 TownshipRange 1 <br /> Original Description(or attach copy): UC. �*' tt (- '�c o <br /> l j <br /> z n <br /> r <br /> At G.- � s <br /> Current Zoning: A Z Floodplain Y/N: !�1 Wetlands YIN: / Lake/River Class. A , <br /> II <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: Alf <br /> . i <br /> Farmland Preservation YIN: fit Managed Forestry Law Y/N: /1✓ <br /> New Parcel Information z ' <br /> 7' <br /> Proposed New Legal Description and Parcel Size: Z. L oT G$� . /3.3 ' f1.. $ T • <br /> i.3, / d Ac <br /> f r <br /> Acres: K S <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) Y <br /> Proposed access to public road: e S-2,, N . pert,,�-`� p)r ve,„v,,-�s c <br /> sr <br /> Proposed access to public waters to be provided '. . kf <br /> If yes,describe access: <br /> Signature of Owner: 9a4riaVeda Date: 7/2/2024 <br /> Signature of Owner: Date: <br /> Fee Red/300 <br /> Does parcel meet Zoning Requirements? Yes No 33s8 <br /> Check#: <br /> Does parcel require a Survey? Yes No <br /> Reconciles with Real Property Lister Yes No Date: r— �� <br /> tv <br /> a <br /> It not,explain: cn m co C <br /> Cn <br /> t7O Vl <br /> Applicati : Approved / enied Reason for Denial. t, J N.) <br /> Land lise: > Date: m <br /> iffil <br /> f/ 29 20 zy C:::1 <br />