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Pees(must accompany form): <br /> Burrett County Subdivision Permit Application Subdivision w/oSuncy: $50.00 <br /> Survey of Existing Parcel: 550.00/lot <br /> and/or Pre-Application Form Sukkisionw/Survey. 5200.00+550.00/lot <br /> Owner: _:1Ic714d r, nr"' Buyer: __ 9 <br /> A <br /> Address: C'r s S IrZr 'k'c�ci Address: <br /> P <br /> Phone: <br /> _252 - `I/3 - 5C20 Phone: _ <br /> Ln <br /> Orieinal Parcel Information <br /> Parcel ID#: Section_Townshi y✓,p ,,t/ Range <br /> 7 <br /> 11,, O <br /> Original Description (or attach copy): Ki l Ka e G,-et%_tt '46A t0 L' - <Ia QA" o <br /> Current Zoning: P�{ > Floodplain VIN: A Wetlands Y/N: Al Lake/River Class: <br /> m Name of Water Body: Shoreland Agreement/SIPS Y/N: m <br /> Farmland Preservation Y/N: Managed Forestry Law v/N: <br /> New Parcel Information p <br /> Proposed New Legal Description and Parcel Size: .^ r c� ,� 11 �/� c��l i 23 <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: f9 <br /> If yes, describe access: w <br /> 75 Signature of Owner: Date: <br /> Signature of Owner:_ Date: c <br /> c <br /> s Does parcel meet Zoning Requirements? )'es No <br /> v Does parcel require a Survey? Yrs No <br /> o i <br /> °O r Permit applicalion fees submilled? L Amounf$ a 0 00 Receipt# <br /> r ❑ Reconciles with Real Property Lister Yes No Date: <br /> m � <br /> o <br /> a If not,explain: <br /> n <br /> O <br /> H <br /> Applicatio . pproved enied Reason for Dental:_— <br /> _ BURNETT COUNTY <br /> ZONING <br /> Land Use: _ �� 2 z%s�Date: <br />