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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/ Survev $200.00+$50.00/lot <br />Owner <br />Owner: Albert C. Grabow, Jr. R Theresa L. Leffelman <br />Address: 5225 SW 8th Place Address: 1015 Pembridge Place 5 <br />z <br />Cape Coral, FL 33914 Sugar Grove, IL 60554 <br />630-204-7536 630-421-0224 <br />Phone: Phone: <br />Original Parcel Information <br />Parcel ID #: 07-036-2-40-17-23-505-003-018000 Section 23 Townshi 4p 0 N Range 17 W <br />Original Description (or attach copy): PCL GOV LOT 3 EX CSM V 10 P 344 <br />Current Zoning: RR1 Floodplain Y/N: Y Wetlands Y/N: N Lake/River Class: <br />Name of Water Body: Little Yellow Lake Shoreland Agreement/SIPS Y/N: <br />Farmland Preservation YIN: Managed Forestry Law Y/N: <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size. New 1 Lot CSM <br />Acres: <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: Existin <br />Proposed access to public waters to be provided Y/Y: <br />If yes, describe access: <br />Ir-- <br />rb <br />P <br />S <br />d <br />on <br />N <br />t <br />ENV <br />A <br />Signature of Owner: <br />Date: December 31, 2018 <br />n <br />Signature of O n r,. Lri���-� <br />Date: December 31, 2018 <br />eresa e e man <br />➢ Does parcel meet Zoning Requirements? Yes <br />No <br />C/�i .0- I87 7 9 <br />GL Z—' -7 fi <br />➢ Does parcel require a Survey? Yes <br />� <br />rrNo <br />� �J <br />➢ Permit application fees submitted?!] Amount S <br />7� � <br />Receipt # <br />r., <br />]1 <br />❑ Reconciles with Real Property Lister Yes No <br />Date: <br />7 <br />If not, explain: <br />n <br />0 <br />z <br />y <br />Application Approve Denied Reason for Denial: <br />Ir-- <br />rb <br />P <br />S <br />d <br />on <br />N <br />t <br />ENV <br />A <br />