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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision N%,/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 /> Ow er*c Lliyi% l T u5} bri- R�9JDIBuyer: b <br /> Address:ZV02 G 'Rick SG-rJ L0 jk Address: 3 <br /> Phone: Phone: W <br /> Ori¢inal Parcel Information <br /> Parcel ID 3./-3- o5-oca 13Da> Section 23 Townshi 3p 911 Range /,5-IJ <br /> 1 ^1 O <br /> Original Description(or attach copy): L_0 <br /> A <br /> "o Current Zoning: Floodplain Y/N: Wetlands Y/N: Lake/River Class: <br /> Name of Water Body: i3i G &x r A kJ e- Shoreland Agreement/SIPS Y/N: <br /> o '~ <br /> .. Farmland Preservation Y/N: Managed Forestry Law Y/N: -� <br /> New Parcel Information nn <br /> Proposed New Legal Description and Parcel Size: e. ) C SYV\ Xr o5 P1 <br /> Acres: <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 21<?'S 4f n Q p <br /> Proposed access to public waters to be provided Y/N: ^' <br /> If yes,describe access: <br /> Signature of Owner: I ru-Sfe, Date: 9 5 <br /> Signature of Owner: _ — Date: 3 <br /> c <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> Y Does parcel require a Survey? Yes No <br /> °Q ➢ Permit application fees submitted? Amount S _ Receipt# _ <br /> t" ❑ Reconciles with Real Property Lister Yes No Date: <br /> c <br /> a <br /> If not,explain: <br /> X -- <br /> m <br /> n <br /> 0 <br /> li R <br /> Application• pproved Denied Reason for Denial: __— 2 <br /> —0 <br /> Land Use. �_� s �s� Dale: BURNS MCO INTV <br /> ZONING <br />