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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 /> V v`� V "1 l / 2'/147 yi. fD <br /> Owner: Buyer: d <br /> S/a4. AV 3S- m �» <br /> Address: Address: <br /> w(46 hleAfs rtd -sfl ?3 <br /> Phone: Phone: <br /> Original Parcel Information 0 s•-.l <br /> �y p. �+ p.p t,� C� <br /> Tax ID#: / �/ r 9�� 3 b �, 7O / / Section 3 2" Township / a Range /6 t1/4) <br /> Original Description(or attach copy): G <br /> i. <br /> Current Zoning: 4"Z Floodplain Y/N: Ve." Wetlands Y/N: Ve? Lake/River Class: <br /> . Name of Water Body: / rd tt) /R/(//t4/-' Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation YIN: Managed Forestry Law Y/N: <br /> New Parcel Information <br /> 1 <br /> Proposed New Legal Description and Parcel Size: ybpd s / �/ G�� r <br /> - <br /> Acres: g ,O <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) _ <br /> VJ <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: c, <br /> Signature of Owner: Date: `J 2 <br /> Signature of Owner: Date: <br /> .� Fee Rec: .97, <br /> ➢ Does parcel meet Zoning Requirements? Yes No Check#: <br /> c <br /> ➢ Does parcel require a Survey? Yes No m <br /> z <br /> tr <br /> m <br /> Reconciles with Real Property Lister Yes No Date: <br /> m <br /> If not,explain: <br /> 0 <br /> r- <br /> r <br /> Application: •pprov•' / • •• . Reason for Denial. <br /> Land Use: , ?//377-0 •-Z Date: rn <br /> Ref ui /0 eV <br />