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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 or Map Review Form Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner: L/V 6i1 &T./ S lrui-Buyer: gyanj' <br /> ('- ess l(ij-k4 <br /> Address:,-23M DlAddress: orf .30qf <br /> Si re i7 VJ S 1K 7 :51"re 0 Gil" 5-Vc'7 ,-.. <br /> Phone: Il , 62& -£2' /X Phone: i/c- �5'3 '7221 ^' <br /> 111 <br /> Tai' IP 35I4Le Original Parcel Information <br /> //,, J_ NO <br /> '�(? -* , '- / <br /> Parcel ID#:L')_--OU W✓(� 7j(> /1 ��,' Section 2----Y Township ''-' / ` Range'/VV <br /> Original Description(or attach copy): % ' t 1144 .4 1104 A i 514 • 2- L . <br /> 14� 81 d 35ail) ,v or Daiiimmt C ' n <br /> N,f <br /> -Re <br /> //�� <br /> ' <br /> Current Zoning:A-2- Floodplain Y/N: Y Wetlands Y/N: Y Lake/River Class: <br /> ti Name of Water Body: V v Udo) C rep Shoreland Agreement/SIPS Y/N: NI Di <br /> N I <br /> �' Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> G kIN <br /> .. New Parcel Information <br /> ProRosed kei Lege)Description,and Parcel Size: S' - _ 471.` ..it <br /> ilia . rl d <br /> ;, 4,,, i I, i - . • I" <br /> ; t <br /> ill <br /> (If pa ce is to ,e surveye• o 1 • p e e8. inary map. See attac-hor preliminary map requirements.) d <br /> Proposed access to public road: h A- ( .1YA y t) N..1 <br /> '�,(�/'�JlProposed access to public waters to be provided Y/N: �la, (Air-may <br /> t), , <br /> If yes,describe access: <br /> . <br /> Signature of Owner: .Sti...47r-, MA5{ei �I15a0� Date: p ' z <br /> Signature of Owner: Date: <br /> c vi' <br /> > Does parcel meet Zoning Requirements? Yes No �' 63V7/p �n � <br /> N ➢ Does parcel require a Survey? Yes No ,ge 7/ 9/e 2 / U' <br /> o <br /> Permit application fees submitted? 0 Amount$ 56• Receipt# <br /> wa <br /> 131 Reconciles with Real Property Lister 6D No Date: 7/0a.1 <br /> r <br /> Po If not,explain: <br /> 0 <br /> a <br /> n <br /> 0 <br /> 0 <br /> °. Applicatio • Approved / enied Reason for Denial: <br /> y Land Use: 7 /0 eez/ Date: <br />