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Fees(must accompany form): <br /> Burnett Count Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> Y PP Survey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application Form or Map Review Form Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: l/'4U1 &46,, l 5�- l roily Buyer: eJ e *41r- <br /> Address: (9V&� aT3 iG7� /IVV� 4U-Z' Address: �� <br /> (A)C6Sl�Pr <br /> Phone: Phone: <br /> o OrilainalParcelInformation <br /> 01 <br /> $ a-39- Jb 36- Q. -611- 000-6i 6 6 / <br /> Parcel ID#: (�/ �- -3 -336 - 03- 160 Section 36 Township 3`1 _ Ra rge <br /> Original Description(or attach copy): S,E S cc-- 3( �73cf—i- K I 6 w <br /> �lT <br /> Current Zoning: _Floodplain X/&-.: _ Wetland�5N: Lake/River Class: <br /> o Name of Water Body: LdA1114Ine9 l Shoreland Agreement/S S Y� <br /> k' <br /> m Farmland Preservation /N: Managed Forestry <br /> /Lav Y <br /> New Parcel Inffonormation 77�/, a 1 f 772G—,904, <br /> , 7� <br /> Proposed New Legal Description and Parcel Size: <br /> r e� 3v Acres: <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) O <br /> Proposed access to public road: E'41341 nG 6 rl v e- '70 A 1 4F'li Se/hetL� <br /> U S <br /> Proposed access to public waters to be provided YC� � <br /> If yes,describe access: <br /> Signature of Owner:) LAC. Date:x/ <br /> m c <br /> Signature of Owner: Date: <br /> ➢ Does parcel meet Zoning Requirements? Yes \ No <br /> N ➢ Does parcel require a Survey? Yes No o0 <br /> e fi (1J <br /> ➢ Permit application fees submitted? Amount$ D�) Receipt# .w <br /> d � <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> r /ALu <br /> � If not,explain: GOA/ F /�/pfe— FticrDa�lme„t is oyer GxtsfK� LineeSm- � <br /> a <br /> z Does X'I 0'rPr No„ (fir Furmt�c, 13Sued . Oy"r� 6tl41Are_ i9f` _ht Id <br /> o c` <br /> a Application: Approved / Denied Reason for Denial: G <br /> Land Use: / Date: <br /> /l/S ( /�2 ? G0 C Ll��[Jf /�l��✓� 4 <br />