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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivisionw/o Survey: $50.00 <br /> Survey of Existing parcel: $50.00/10t <br /> and/or Pre-Application Form Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: �o.tl - �orc�h S"F2c Buyer: <br /> Address: \\\�� Crec�vli.w\ GA. Address: 3' <br /> z <br /> 236q(9 67h 11.4( 914 <br /> Phone: Phone: <br /> pu00j611(oll,bI'/ vs Oriainal Parcel Information <br /> Parcel ID#: O1 N0- 14'24- O-).- 6s� S Section Township�_Range_— <br /> O <br /> t� f <br /> Original Description(or attach copy): G 5 YY\ V D.A <br /> C_-s 20 , Pctiu�u �3 is- \3� 1-01S /0�)! Auld t!u�3 IZ-is <br /> 'o <br /> J <br /> 10 Current Zoning: V�U Z•n.d Floodplain Y& Wetlands ) N: <br /> Lake/River Classification: Name of Water Body: — o <br /> b <br /> Shoreland Agreemt or SIPS Y&- Farmland Preservation YQi =Managed Forestry Law Y&.-= <br /> New Parcel Information yI, <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: 30 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Ex i I s' a 0 - d <br /> Proposed access to public waters to be provided Y& <br /> If ves,describe access: 0 <br /> d <br /> c Signature of Owner: Date: pQ <br /> 0 <br /> n <br /> Q0 Signature of Owner: Date: 3 <br /> c <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> x <br /> ➢ Does parcel require a Survey? Yes No 0 0 o p 0 <br /> Is- s6 � <br /> Permit application fees submitted? ❑ Amount$ Receipt# <br /> wWez4: s <br /> o. W� W y 4' ➢., <br /> h ❑ Reconciles with Real Property Lister Yes No Date: c c <br /> o <br /> If not,explain: , <br /> � _s <br /> 6 6's � <br /> VY - <br /> Applicata . A enied Reason for Denial: <br /> Land Use 1/i"�2 Date: 3- 3 -o <br />