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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 /> CA <br /> cA et <br /> Owner: 1✓r1Q'ok f 4G,' /14744 Buyer: C B <br /> Address: <br /> �!oCO uQQ Jtt w <br /> l � Address: A <br /> p ['q <br /> T1NG �S/4NI/ ,,,v ,cJ /C3 k) C <br /> Phone: Phone: <br /> O <br /> Original Parcel Information <br /> Tax ID#: 18 59 a ? 33911 Section ���Township L_lRange /V <br /> Original Description(or attach copy): G <br /> C <br /> eo <br /> p �p � <br /> Il <br /> Current Zoning: g-3 Floodplain Y/N: ,A vj Wetlands Y/N: / Lake/River Class: <br /> ■ <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Information Q/ <br /> Proposed New Legal Description and Parcel Size: C H 14 ? P 4 a <br /> Acres: a <br /> I <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: E <br /> If yes,describe access: W <br /> -C J‘ <br /> Signature of Owner: Date: ` *o <br /> Signature of Owner: Date: <br /> , Fee Rec: 'OO,.ip <br /> ➢ Does parcel meet Zoning Requirements? Yes No Check#:/Z <br /> N <br /> ➢ Does parcel require a Survey? Yes No rr <br /> v <br /> z ��=� <br /> [TR <br /> 11 <br /> Reconciles with Real Property Lister Yes No Date: < co m <br /> 5 co <br /> If not,explain: y cp u pip <br /> ao <br /> Q <br /> Application 1 enied Reason for Denial: �Q I <br /> Land Use. TA I'S TZK4 I p/47 g p,rvi/`C�- 0�'1 2///- 2..2_' \.C.---)j <br /> rr <br /> 29,4•4 2/i Zo Z Z- <br /> a <br /> -o <br />