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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: $50.001lot <br /> and/or^Pre-Application Form Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: Buyer: �_�L9�� y <br /> Address: <br /> Address: <br /> tot <br /> Phone: 73 5 Phone: �U/✓ - 732 - FS2 TZ <br /> Orit=_inal Parcel Information <br /> 9N 9 _� DD S+f�l Section-0-0—Township Range <br /> f po, <br /> Parcel ID#: Section <br /> Original Description(or attach copy): Goa, Lr-1-rr �!6Z �2� <br /> / o <br /> 4/74.fl Current Zoning: Floodplain Y/N:_ L—Wetlands Y/N: Lake/River Class: <br /> m Name of Water Body: Shoreland AgreemenVSIPS Y/N; Al <br /> o <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Information r <br /> Proposed New Legal Description and Parcel Size: LSee <br /> Acres: <br /> (If parcel is to be surveyed provide preliminary map. See attached for preliminary map recJrements.) <br /> Proposed access to public road: <br /> m <br /> Proposed access to public waters to be provided Y/N:/_ <br /> O <br /> If yes,describe access: 1 h <br /> Signature of Owner: Date: Z z ZOOS <br /> Signature of Owner: Dat : > n <br /> 0 <br /> 3 <br /> ➢ Does parcel meet Zon g Requirements? Yes No <br /> d ➢ Does parcel require a Survey? Yes No <br /> O 7/r�� <br /> 00 ➢ Permit application fees submitted? Amount$✓y.�--1/xCp� Receipt# <br /> r econciles with Real Property Lister Yes No Date: <br /> 0 <br /> If not,explain: <br /> 7y <br /> m <br /> 0 <br /> ti <br /> a <br /> h <br /> Applicatio Approved / D led Reason for Denial: <br /> Date: <br /> Land Use µ�—� <br />