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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/Survey: $200.00+$50.00/lot <br /> P b <br /> Owner: p...0 lPot Buyer: to@ <br /> Address: Address: P <br /> of <br /> Phone: Phone: <br /> Original Parcel Information .z <br /> Parcel ID#: j( IW, 35c?$ Section 17 Township2o Range /it/ <br /> O <br /> Original Description (or attach copy): <br /> Lot 2- c 14 V, Z8' Py, At/ CD <br /> CD <br /> ,....t.....) <br /> Current Zoning: h R-I Floodplain Y/N: Wetlands Y/N: Lake/River Class: <br /> o Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> .o <br /> w' Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> 0rii <br /> �. New Parcel Informatiioon <br /> Proposed New Legal Description and Parcel Size: M(K' Ptc <br /> Rec .51-414e <br /> -- <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) d <br /> 14 <br /> ez <br /> Proposed access to public road: *3' <br /> Proposed access to public waters to be provided Y/N: <br /> If yes, describe access: 1v <br /> b <br /> Signature of Owner: Date: <br /> Signature of Owner: Date: <br /> 0.xtkl <br /> D Does parcel meet Zoning Requirements? Yes No * 6o 3 77 ,Gi <br /> ,,D <br /> © <br /> )=. Does parcel require a Survey? Yes No <br /> 0 .. 'O 0 <br /> Permit application fees submitted? ❑ Amount$ � ��" Receipt# <br /> CM <br /> 0 Reconciles with Real Property Lister Yes No Date: <br /> o If not,explain: <br /> a <br /> n <br /> 0 <br /> O <br /> a. Applicatio Approved / ! •nied Reason for Denial: <br /> Land Use: - 0111 / kr44 cetb,4,o W Date: <br /> 011 S 6/7.02.1 0/7- <br />