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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: $50.00aot <br /> and/or Pre-Application Form or Map Review Form Subdivision w/Survey: $200.00+$50.00/lot <br /> b <br /> Owner: S.1 f(:/I,y A/tk/c./Al Buyer: g, <br /> . R <br /> Z <br /> Address: 5O 5° kimgefa y 1,4416 N Address: <br /> 171-fMot r1+-t MN 5644-6 <br /> tr <br /> Phone: rot Z- 32,5--(cl Z Phone: <br /> Original Parcel Informationis <br /> Parcel ID#: 07-04Z-2-36-613-34-5 15-M-014-foo Section 34. Township `j8 Range I Ei <br /> O <br /> Original Description(or attach copy): (-'T 4" oP h4.1S oN f POIAIT5 i O f8TEk iz_ k!171#A- 4 <br /> ev <br /> Pott-iorJ 0 TJX .4a72v,vpv9 VAAe41-eD Ra40WAV /A} y.L, i ofop Section 3+ ;.?) <br /> . T• Zoning: R2! Floodplain Y/N: N Wetlands Y/N: N Lake/River Class: 7C <br /> Name of Water Body: W o OD) L4icE Shoreland Agreement/SIPS Y/N At <br /> b <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: A Z <br /> P. <br /> New Parcel Information (6 <br /> E <br /> Proposed New Legal Description and Parcel Size: L-oT / of New GSM COM6/NIAJ5 Lor 4- <br /> win* ADOc ei•i r I44c/fTh Ro40 WA y. ¢ <br /> Ac G4-TEP Ro11,1Y4I3:,- A <br /> a, 344• <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) m <br /> etProposed access to public road: HA—I.1 Se n faalAIT 2644U 4.- <br /> Proposed access to public waters to be provided Y/N: f4 �j <br /> If yes,describe access: <br /> 13 <br /> 5. 6 -x/ b <br /> Signature of Owner: Date: z <br /> Signature of Owner: Date: <br /> Ul <br /> C& <br /> ' [�' <br /> • Does parcel meet Zoning Requirements? Yes No 016 at/ VJ <br /> N Y Does parcel require a Survey? Yes No <br /> 00- <br /> • Permit application fees submitted? ❑ Amount$ --CO' Receipt# <br /> fig Reconciles with Real Property Lister es` No Date: z., - i4 -a+ <br /> L-4 <br /> a If not,explain: <br /> a <br /> C <br /> 7 <br /> 0 <br /> F.:', Application- A proved /v!enie u •ason for Denial: <br /> Land Use: WZ. Date: <br /> moi__-I �� <br />