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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/Survey: $200.00+$50.00/lot <br /> Owner: C c-1 N O km1/4(3 a ai Buyer: NM .d <br /> Address: ) ‘i 1 3 3 /8is Ycc,� Address: i <br /> C v mb c< <wv 5"i$2q o <br /> Phone: Cts) f 5 O 3 1 1 Phone: 03 <br /> Original Parcel Information o- <br /> 01 - .o O - o%Oo O 64. <br /> Parcel ID#: ()1— 0 22-- 2-31"1 a-3 i—` Section 3 4 Township 3 7 Range ( y U oc-11, <br /> Original Description(or attach copy): <br /> A <br /> Current Zoning: I\ ' Z Floodplain Y/N: t\I Wetlands YIN: /' Lake/River Class: I/ 69 - <br /> a. Name of Water Body: iv ` A Shoreland Agreement/SIPS YIN• <br /> Farmland Preservation YIN: "` Managed Forestry Law YIN: f <br /> New Parcel Information 6 <br /> Proposed New Legal Description and Parcel Size: LOT> 1 4 Z <br /> Acres: <br /> (If parcel is to be surveyed,provide/�S 'preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: '/ v L,;46 C <br /> l // m <br /> Proposed access to public waters to be provided Y/N: Al A <br /> ,-c-, <br /> If yes,describe access: `�,l i� <br /> Signature of Owner: k-� Date: ' I 1 412 ozv ,.a <br /> Signature of Owner: Date: c <br /> 3 <br /> iz <br /> ➢ Does parcel meet Zoning Requirements? Yes No A <br /> )ec 9/11 (To , g <br /> V > Does parcel require a Survey? Yes No <br /> 338" <br /> m <br /> 50 > Permit application fees submitted? 0 Amount$ '3�`1 - Receipt# $(.. <br /> C., Ei Reconciles with Real Property Lister (_° .--_:_a No Date: q--2.6;-22,6 <br /> m <br /> 0 <br /> a. If not,explain: <br /> 70 <br /> R <br /> 0 <br /> a <br /> Application. Approved Denied Reason for Denial: <br /> 7/1 i S /S 1.4 5/'rt q -/-A c- gleAA S/.79 G Opti PM/1)re.✓'S/Oin t <br /> Land Use: 52P.4.4_ . '? --.S1 /O0/2.49 Zp Date: <br />