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Fees(must accompany form): <br /> Burnett Count Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> County IIII Surve of Existin Parcel: $50.00/lot <br /> and/or Pre-Application Form or Map Review Form ❑bdiwsionw .arvev: oo.00+$So.oalnt <br /> L-/00. v a <br /> A <br /> Owner: FM IYIIR kO IGL er <br /> Buyer: <br /> Address: 90 a KvlanG�e1- \j Address:s: 3z <br /> Phone: /I S- 65-3 13 8�S Phone: <br /> 0r2_0042-l 5 OS%ri¢inal Parcel Information <br /> Parcge 1 # 006-oa4 as-o3 -!!5 00 Section C Township3 b NRange <br /> z <br /> or 9- 3Sec- �2 39 Rl� w n1 <br /> ooati,)a-oa-LlW (2t- 0) 3 <br /> - oU0 -3 l as o5 ova-o l l00 R1 <br /> Current Zoning: 'Floodplain Y� YJ Wetlands Lake/River Class: O <br /> Y Name of Water Body: N A- Shoreland Agreement/SIPS Y� <br /> �o <br /> Farmland Preservation Ye-Managed Forestry Law Y N• <br /> New Parcel Inforrmation <br /> Proposed New Legal Description and Parcel Size: "1 v ` o I 1 O <br /> NO <br /> Acres: 5�e cs/n <br /> (If parcel is to be surveyed,provid/e�preliminary map. See attached for preliminary map requirements.) O <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y 9 <br /> If yes,describe access: /V A- 91 <br /> n <br /> Signature of Owner. x�i YL _ _ _ _ y - _ Date: <br /> Signature of Owner: jt Date: ° <br /> A <br /> _ z <br /> ➢ Does parcel meet Zoning Requirements? Yes No d Tj v_AQouA- <br /> U� <br /> N ➢ Does parcel require a Survey? Yes No <br /> 0 <br /> Permit application fees submitted? Amount$ 0-o Receipt# <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> r <br /> � If not,explain: <br /> a <br /> 77 <br /> m <br /> 0 <br /> a Application: Approved / Denied Reason for Denial: <br /> N <br /> Land Use: Date: <br />