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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 Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner: E`J7-C^'1o'f'-Vh TTflI/1e n Buyer: RX ,k N c v i ( an <br /> b <br /> A <br /> Q <br /> Address: a (a �VACA d PKL fl vA)1 Address: R ec` Da-v-) '2 <br /> 5PaAK\ *nn55i16 <br /> Phone: Phone: • ., <br /> el-0'6 kr a-Lb-n --5 b5nub- rigina arcel Information CT <br /> otgo0A <br /> Parcel ID#: 0-1p� 'a-4e,-}1-�-5 05-wooncc Section 091 Township LtQ Range 1 �( <br /> O <br /> Original Description(or attach copy): VIb 4 C(v\ \ rc* �o l//D a <br /> eB <br /> Tax 1lYs ,a4593 ,A.45aa, Q4511 a459O <br /> Current Zoning:9-10.a` Floodplain� lY/N: N Wetlands Y/N: Lake/River Class: <br /> m Name of Water Body: �t1�T"t �(��'� Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: Nill <br /> ► fi <br /> New Parcel Information j 5 <br /> Proposed New Legal Description and Parcel Size: 0-3rr\ 5 <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C <br /> a <br /> Proposed access to public waters to be provided Y/N: I° <br /> C1,1 <br /> If yes,describe access: <br /> � <br /> Signature of Owner: �° <br /> Date: �� / Z" <br /> Signature of Owner: Date: 5/ Z Co) <br /> / 5 <br /> .0 <br /> > Does parcel meet Zoning Requirements? Yes No <br /> 6o3gS--- eo <br /> N <br /> c > Does parcel require a Survey? Yes No <br /> a <br /> °fQ > Permit application fees submitted? ❑ Amount$ /So i �- Receipt# v` <br /> W • <br /> ®Reconciles with Real Property Lister Yes No Date: 5-,Q6-Q,l <br /> N <br /> o. If not,explain: r <br /> n „Q <br /> 0 <br /> 6.- <br /> LN <br /> 4) <br /> Applicata : Approved / enied Reason for Denial: „Q\ <br /> cl <br /> Land Use: , 6 3 Zd Z f' Date: <br />