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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/lot <br /> and/or Pre-Application Form or Map Review Form Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner '4t� �� �J Buyer: 3 <br /> Address \� ��� Address: z <br /> Q 0 <br /> c� <br /> Phone: Phone: � <br /> Original Parcel Information C <br /> Parcel ID#: spa attnrhn3 Section 2 Township 38N Range 18W <br /> Original Description(or attach copy): Fractional NE NE, 2-38-18 �l <br /> ���H �• y. <br /> Current ZoningFloodplain Y/N: V Wetlands Y/N: 114 Lake/River Class: N/A <br /> D Name of Water Body: Shorelandd Agreement/SIPS YIN: n <br /> Farmland Preservation YIN: N Managed Forestry Law Y/N: N <br /> 0 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: SPP attached <br /> Ten acres to be retained by owner; remaining 3D acres of this C1\ <br /> parcel to be sold. Acres: <br /> W <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) d <br /> Proposed access to public road: County Road D (� <br /> Proposed access to public waters to be provided YIN: N/A <br /> If yes, describe access: <br /> d <br /> G, v o <br /> Signature of Owt // Date: 0 3 <br /> Signature of Owner: Date: (i <br /> W <br /> ➢ Does parcel meet Zoning Requirements? Yes No CO <br /> c ➢ Does parcel require a Survey? Yes No ocb <br /> 0 <br /> ➢ Permit application fees submitted? Amount$ .. l Receipt# <br /> �1 G <br /> �1 Reconciles with Real Property Lister f No Date: <br /> � If not,explain: <br /> 0 <br /> a C <br /> 0 <br /> a Application: pprov Denied Reason for Denial: <br /> y Land Use: Date: <br />