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Fees(must accompany torm is <br /> ` l unz sett County Subdivision Permit Application Subdivision w/o survey: 550.00 <br /> Survey of Existing Parcel: 550.00/lot <br /> and/or Pre-Application Form Subdivision w/Survev: 5200.00+550.00/1,ot <br /> Buyer. r- <br /> Address: _ /2 / r`"v Address: D C SOPS 692 [R y4A.o I C-J* 3 I <br /> Phone: 306 D Phone: <br /> Onix al Parce nformation <br /> Parcel m#: 4.7_d 3?- a'y� Section Township <br /> �IIN Range AV_ W <br /> Original Description(or attach copy): <br /> G6 T- 1-6 7- <br /> p <br /> a <br /> Current Zoning: ^1�2 Floodplain li Wetlands <br /> .. Lake/River Classification: 3 Name of Water Body: <br /> Shoreland Agreemt or SIPS Ye) Farmland Preservation A& Managed Forestry Law r <br /> New Parcel Information CSM V � �, ocU�—aV� <br /> Proposed New Legal Desc . tion and Parcel Size: lge—di V �,10AI Qf— Z-672 °? <br /> Acres: a'5 /0 <br /> (;f parcel is to be surveyed,provide preliminary map. See attach d for preliminary map requirements.) <br /> Proposed access to public road: 0j& d <br /> Proposed access to public waters to be provided <br /> If ves,describe access: (.1 <br /> Signature of Owner: Date: j <br /> Signature of Owner: Date: `0 <br /> S <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> o st <br /> ➢ Does parcel require a Survey? Yes No <br /> as <br /> Permit application fees submitted? Amount$ M, Receipt# <br /> m ❑Reconciles with Real Property Lister !!! Yes No Date: <br /> 0 <br /> a <br /> ro If not,explain: <br /> 0 <br /> a <br /> Vl <br /> Application Approved Denied Reason for Denial: <br /> Land use: 7 3'0 /S - Date: BURNETT COUNTY <br /> ZONING <br />