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Fees(inust accompany form). <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey $50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application Form Subdivision w/Survev: 5200.00+S50.00not t <br /> Owner: tiMhawt * Sherd) Summef 5( Buyer: KRlhkjawrs L OW^ A <br /> Address: (oO c> (auvcl v/ IZL� A Address: o?9;1 k I Sohn-son 4eLkt 2 d. 3 <br /> z <br /> I,�oks et l w1 S�/Sr93 �ns �t� w'r ,5-41Fr'Y3 ° <br /> Phone: Phone: <br /> Orieinal Parcel Information <br /> Parcel ID#: Section_l�Township qO Range 1(0 <br /> �1 <br /> t� O <br /> Original Description(ot Attach copy): See aAacka J� CSNn n <br /> Current Zoning: Aa Floodplain Y N WetlandsY/N: Lake/River Class: <br /> _ . <br /> m Name of Water Body: Shoreland Agreement/SIPS Y N <br /> 0 <br /> w <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Information C�n��� <br /> Proposed New Legal Description and Parcel Size: 1-AS 5- + (0 e t CSW -0clsg3 <br /> Acres: 37. /1 <br /> (If parcel is to be surveyed,provide preliminary <br /> \map. See attached for preliminary map requirements.) <br /> Proposed access to public road: M u v�`ty A 0 <br /> Proposed access to public waters to be provided Y6-) <br /> If yes,describe access: <br /> Signature of Owner: Date: <br /> Signature of Owner: Date: _ P1 <br /> 3 <br /> r Does parcel meet Zoning Requirements? 1"es No A <br /> u <br /> r Does parcel require a Survey? Yes No <br /> Q0 i Permit applicationjees suhmitted? ❑ Amount$ ��� ' Receipt 4 <br /> t• ❑ Reconciles with Real Property Lister Yes No Date: <br /> d <br /> a <br /> If not,explain: <br /> O <br /> NOV 10 2016 <br /> ApplicatioApproved / enied Reason for Denial:_ J_W_ 0 <br /> Land Use: Date: ZENINIS <br />