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I <br /> Fees(must accompany form): <br /> Burnett County Subdivision Permit Application I Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parcel: $50ot <br /> and/or Pre-Application Form I Subdivision w/survey: $200.00M+4$50.00/lot <br /> , qq i Q r--- 1 <br /> Owner: v\Jtroch CZ1 fir- _:_L-!.. C Buyer: JOS AAA- t4f+U .,y <br /> p 0 <br /> Address: 311 3S �.c.\ € F.c' -- Address: ( 57 4 S C i i �t_es (c1. i <br /> ON:+ iso <br /> 00.11 ,.,s 14 to14 t AA) .55-110 AV ,( ; k�r Si/8oG <br /> 1 - 330 3 <br /> Phone: 5 _ Lt U Phone: 1 t c - C$7- - 81439 G <br /> I <br /> Original Parcel Information <br /> Parcel in#: o 1-oo G-2-T6-J-7-206-3- Section Z.8 Township 3'8 Range (� o9 <br /> IP- <br /> 0 1 -Geo- bttatot <br /> Original Description(or attach copy): Ai e -5t3 3 Sec.}iwl*‘• -Ler j 3 S.O, R!7 L i <br /> F <br /> • <br /> A � / i <br /> b Current Zoning: Floodplain Y/N: !Y Wetlands Y/N: ti Lake/River Class: -- 1 <br /> c o -9 <br /> aName of Water Body: �- Shoretand Agreement/SIPS Y/N: '^ rn <br /> Farmland Preservation Y/N: Ai Managed Forestry Law Y/N: ` . F- <br /> r~— New Parcel Information - <br /> Proposed New Legal Description and Parcel Size: '- SM. j e-hz cti 4c--e-Le . <br /> eeit ti .i ea Sc, Pay 't't [ <br /> [ Acres: ( D a...e . <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: V�Vel e.� 1 -e_ Ra C <br /> Et.. <br /> Proposed access to public waters to be provided YIN: AI to <br /> If yes,describe access: <br /> Signature of Owner: f✓\+13- ---rx' c oak-K;\reA L-L( - Date: E a-a b--2-0 <br /> Signature of Owner: Date: 1 <br /> ➢ Does parcel meet Zoning Requirements? Yes No B <br /> NO f{ jer4I'llt <br /> ���---www C <br /> V ➢ Does parcel require a Survey? Yes No <br /> Permit application fees submitted? 0 Amount$ T/ Receipt# <br /> t, 0 Reconciles with Real Property Lister Yes No Date: _ <br /> 0 <br /> a. If not,explain: <br /> Xs <br /> 0 <br /> 0 <br /> a <br /> to <br /> Application: ip�sued sated Reason for Denial: <br /> Land Use: ///Zo eta Date: <br />