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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 /> 1 b <br /> eo <br /> Owner: e,n n eA-h Chen Buyer: = ''n <br /> d ,. <br /> ?�S7 0 ne Ave., Address: z <br /> Address: <br /> Cay enter, MN 601-2-- N, , <br /> „..1- , <br /> ,,.._ , <br /> Phone: Phone: <br /> Original Parcel Information <br /> Tax ID#: S Section_11_Township t+ `1 Range ‘SVv <br /> Original Description (or attach opy): L6-11-S 1 CI o.-rid gU if S �e S� O <br /> AA -\--o Voyager V. <br /> Ivc e , <br /> Current Zoning: Floodplain Y/N: Wetlands Y/N: Lake/River Class: i` <br /> Ilk <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: b <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel information AA ,^� II <br /> Proposed New Legal Description and Parcel Size: L o+ I j6ly' <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: j <br /> If yes, describe access: Q <br /> Signature of Owner L �� _ . ------ <br /> Date: 0 CXQ <br /> Signature of Owner: Date: <br /> -� Fee Rec:,( <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> '&1 Check#: 77 <br /> cA <br /> ➢ Does parcel require a Survey? Yes No rn <br /> 0 <br /> t- <br /> > <br /> z <br /> 7 <br /> rn <br /> z <br /> Reconciles with Real Property Lister Yes No Date: F) m <br /> Eiji <br /> w c. -7- <br /> If <br /> If not,explain: a CD D^ <br /> 1 N <br /> '+t . <br /> N C.4.1 <br /> 0tD = uuu <br /> co <br /> `C 0 C N <br /> Applicata Approvers-yenied Reason for Denial: n'on, N <br /> ri 3 <br /> Land e: Date: IJ i U <br /> -,24.47,..,,.7l/r-e 02-- r, <br /> 1 <br />