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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: $50.00/1ot <br /> and/or Pre-Application Form Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: I{ oMAS K�2�� -L� I lJ Buyer: ?'J/A <br /> -o <br /> m <br /> Address: 7581 t)i oRiC" LANe' Address: <br /> o <br /> Phone: ��� — — �� Phone: <br /> O�_ Original Parcel Information <br /> O-L3o Za <br /> Parcel ID#: 086 ZY0 (02 �00 5 Section���7Township JtJ Range <br /> 006— Z%-jLOOZ 900 .Sec+,-C-g <br /> Original Description(or attach copy): A <br /> Vjav <br /> Cidtc <br /> A p — <br /> Current Zoning:' S __Z Floodplain Y/N:, N Wetlands Y/N: <br /> Lake/RiverClassification: 1 Name of Water Body: Mt-0 0�✓✓y L/Ae it <br /> Shoreland Aereemt or SIPS Y(N) Farmland Preservation N Manaved Forestry Law Y <br /> New Parcel Information $ <br /> Proposed New Legal Description and Parcel Size: 15,urx/t,/ o47 <br /> E�Cr s 1 (\JC:-, PA f? < ECS !S _ N0 C� A-A)G�S <br /> Acres: <br /> (if parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C <br /> m <br /> m <br /> Proposed access to public waters to be provided Y/N: <br /> If ves,describe access: <br /> N Signature of Owner: tJ I'c A^ <br /> Date: O <br /> e ka- A SCA,601 \/'Sjpr\J <br /> Signature of Owner: / Date: f1 <br /> ➢ Does parcel meet Zoning Requirements? Yes No --r) ° <br /> 6� iy�Sov, <br /> m ➢ Does parcel require a Survey? Yes No <br /> O <br /> � h C � <br /> ;0 D Permit application fees submitted? ❑ Amount$ 16 D' V U Receipt# tr <br /> ❑ Reconciles with Real Property Lister Yes No Date: Z <br /> If not,explain: O O� <br /> 000 <br /> G <br /> o � <br /> Applicatio Approved Denied Reason for Denial: q <br /> Land Date: <br />