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Fccs(inusl accompany form) <br /> Burnett County Subdivision Permit Application Subdivision Wo Survcy $5000 <br /> Survey of Existing Parcel S50,00Aot <br /> and/or Pre-Application Form Subdivision WSurvcv: S20000 $5000Au1 <br /> Owner: P/('h,, 7 /rTf/Z Buyer: <br /> ro <br /> Address: i • Address: <br /> z <br /> 0 <br /> Phone: - Phone: <br /> Original Parcel Information <br /> Parcel ID#: /J%- =f 1'/-/J -j %-=3 Section ,r'/ Township T ,,'/Range <br /> F <br /> Original Description(or attach copy): <br /> A <br /> _ Z <br /> _3 <br /> �> Current Zoning: '�SY-Floodplain YIN: /✓ Wetlands Y/N: /✓ Lake/River Class: <br /> Name of Water Body: /X Shoreland AgreemenUSIPS Y/N; <br /> Farmland Preservation Y/N: /,% Managed Forestry Law Y/N: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> /. 'i :x, .r"' Tom,".` S✓r"S� t/�- <br /> /i/i - /�,�-r-;: �/`/`r/ f•`i7 Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminar) map requirements.) <br /> Proposed access to public road: /G j•„ / <',,, / v <br /> m <br /> A <br /> Proposed access to public waters to be provided Y/N: A/ <br /> If yes,describe access: <br /> Signature of Owner: Date: <br /> Signature of Owner: Date. c <br /> b <br /> •c <br /> Does parcel meet Zoning Requirements? )es No <br /> x <br /> o > Does parcel require a Sm-vev? Yes No <br /> Permit applic•alion fees submitted? ❑ Amount S__ Receipt u <br /> �PeReconciles with Real Property Lister es No Date: L <br /> 0 <br /> M. If not,explain:_ <br /> 7y <br /> n <br /> c <br /> a <br /> N <br /> Applicatio Approved / D nied Reason for Denial: <br /> Land Use Date: <br />