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Fees(must accompany form l' <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey. $5000 <br /> Survey of Existing Parcel. $50 004ot <br /> and/or Pre-Application Form / Subdivision w/Survev. 8200.00+55000/lot <br /> Owner: % ;G wll/i //?,-, Buyer: Il F// G��L/'.i ✓% z-r//L 9 <br /> n <br /> Address: MY' Address: 14�� 1%a-" <br /> Phone: /:; — / / ; J` ,3 Phone: e-11 <br /> Original Parcel Information <br /> Parcel ID#: Section% Township_?;,.V Range ,' ';c., <br /> oU0- n/LOGO O <br /> Original Description(or attach copy): <br /> A <br /> , <br /> / � , i /fff'7 iY" j;•/ice Jl,/5/• �%it i Fi' %� <br /> Current Zoning: >- Floodplain Y/N:�Wetlands Y/N: /V Lake/River Class: <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N; / <br /> / <br /> „ <br /> Farmland Preservation l'/N: /I/ Managed Forestry Law Y/N: Al <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> i <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: / '-% /j <br /> v <br /> Proposed access to public waters to be provided Y/N: /(/ <br /> If yes,describe access: <br /> Signature of Owner: Date: <br /> Signature of Owner: Date: <br /> -- c <br /> D Does parcel meet Zoning Requirements? Yes No <br /> st <br /> e r Does parcel require a Survev? les No <br /> Permit application fees suhmitted? ❑ A mount S Receipt k <br /> econciles with Real Property Lister Y'es No Date: <br /> m <br /> If not,explain: <br /> z <br /> A <br /> 0 <br /> Applicatio Approved / enied Reason for Denial: <br /> Land Use: o�"�� Date• P-- <br />