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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/Survev: $200.00+$50.00/lot <br /> Owner: /I GA/yb�7 ��13rl,*tr7' STAG Buyer: <br /> A <br /> Address: ��l'lOk Y�3 Address: //G <br /> va� <br /> Phone: a?�o.Z // ,5'- Phone: ��r G3 s36fl <br /> OriEinal Parcel Information ./ <br /> ParcellD#: �7-�y0 ^x-39//�7-30� - Section .' 7 Township 3f/Range /9A'- <br /> Original Description(or attach copy): <br /> Current Zoning:_AR3 Floodplain Y/N: /V Wetlands Y/N: Lake/River Class: <br /> Name of Water Body: y�� Shoreland Agreement/SIPS Y/N; <br /> Farmland Preservation Y/N: AI&I Managed Forestry Law Y/N: Ala' <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: f/ <br /> r 5w <br /> Acres: CIES <br /> (If parcel is to be surveved, provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: /�//q� nj/STttiJ`M A' p <br /> m <br /> Proposed access to public waters to be provided Y/N:� <br /> If yes,describe access: <br /> r <br /> Signature of Owner: Date: a <br /> Signature of Owner: Date: o <br /> c <br /> Does parcel meet Zoning Requirements? Yes No g <br /> ➢ Does parcel require a Survey? Yes No <br /> 0° ➢ Permit application fees submitted? Amount S 15D°00 Receipt# <br /> C• ❑ Reconciles with Real Property Lister Yes No Date: <br /> m <br /> °a <br /> If not,explain: <br /> 0 <br /> a <br /> N <br /> Application: Approved / Denied Reason for Denial: <br /> Land Use: Date: V 1 8 2015 <br /> BURNETT COUNTY <br /> ZONINI; <br />