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so <br /> 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 Subdivision w/Survey: $200.00+550.00/tot <br /> Owner: i6 ',\P--) ( lC3-rtp.J) Buyer: ,e <br /> Address: L \ 1.111 AVP,- Address: 4. <br /> z <br /> a.(Th r ern )?-L' \P '' (YN) 5-S U"?Co cll <br /> G <br /> Phone: Phone: k <br /> Original Parcel Information P <br /> 6,7--OlD-a-40-.tS-QD-S is-"?cam-Ctx,cbc /j "� <br /> Parcel IDf#:07-O+D- „14p,_s5-a)-5-tS-70�-010ItCCSection 2.2 Township 4f i)Range ) } W <br /> 07-a1 D -,) -`-t ) t5-Z2--5-t 9-705-C>r.SgDOC) 0 <br /> Original Description(or attach copy): a <br /> LoA5 (4a - 5I (3-e- Skyl► c=3hA- Caper. Adel- - VV <br /> -a Current Zoning: lb Floodplain YIN: [ Wetlands Y/V:, Lake/River Class: <br /> Is <br /> nName of Water Body: { Shoreland Agreement/SIPS Y/N; p <br /> Farmland Preservation Y/N: l" Managed Forestry Law YiN: #N <br /> New Parcel information <br /> /`l` <br /> Proposed New Legal Description and Parcel Size: ( 5 r -1--cm 0 Orn i r1 e l 031- <br /> Acres: <br /> *Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> m <br /> Proposed access to public waters to be provided UN: <br /> If yes,describe access: o <br /> ) <br /> Signature of Owner: 972P144/) Date: -1/-J 42Qt'l_ <br /> Signature of Owner: Date: e <br /> 1> Does parcel meet Zoning Requirements? Yes No - <br /> cr� 6ose.S" <br /> > Does parcel require a Survey? Yes No <br /> v? O0 <br /> so .> Permit application fees submitted? 0 Amount$ 52900Receipt# ^_._. _— <br /> m E �l Reconciles with Real Property Lister Yes No Date: (�� / <br /> a <br /> z. If not,exp.`ain: <br /> o <br /> -.1 <br /> a W <br /> Sri <br /> Application- Approved / t enied Reason for Denial: <br /> ...---- <br /> Land <br /> Land Use: 7.#/;4•7e.•e_....Date: <br />