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Fees(must accompanv forth): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.00Aot <br /> and/or Pre-Application Form iw +$5 <br /> /'� Subdivision $200.00+$j0.00/lot <br /> Owner: �/AN C O N R o V e t a �• Buyer: S c 4 ., <br /> n <br /> ,t� <br /> Address: /'" l`� �` /y 'e-0 Y �l/' Address: 3 <br /> Phone: -7 /1 v 9s hone: <br /> Ori inal Parcel Information <br /> py-000-0110 O <br /> Parcel ID#:0-2- �l 1 a'`y `�S`a -3 Section Township Range/ , <br /> O <br /> Original Description(or attach copy): <br /> y o p C/!G f <br /> 5 >� S �✓ S e } . b h r� l,, 7v W s 4 ,� o /1 L <br /> QC-ft krne3d Cv CA is eansip, <br /> > Current Zoning: Floodplain Y/N: IV Wetlands Y/N: IV Lake/River Class:N <br /> n Name of Water Body: Moreland Agreement/SIPS Y/N: /V ' <br /> 0 <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: /V <br /> New Parcel Information <br /> Pr osed 1 Description and Parcel Size: 12 C we S <br /> y� L ►3 vrbef46. .w4 <br /> /U'%v R a h / , W 4 s 7 ar Acres: / v <br /> 17 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: A /pQG d y 6 O rv/p yJ 09%4 It 4.v 2 to u 1 A O <br /> n <br /> Proposed access to public waters to be provided Y/N: N ,� <br /> If yes,describe access: yJ <br /> 00 <br /> Signature of Owner: Date: <br /> Signature of Owner: Date: o <br /> 3 <br /> e <br /> Does parcel meet Zoning Requirements? Yes No <br /> Does parcel require a Survey? Yes <br /> °0 Permit application fees submitted? Amount$_.5E Receipt# <br /> r econciles with Real Property Lister Yes No Date: <br /> y <br /> 7 <br /> c If not,explain: <br /> A <br /> n <br /> 0 <br /> w <br /> Applicatio : Approved /_Alenied Reason for Denial: <br /> Land Use Date: <br />