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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 Subdivision w/Survev: $200.00+$50.00/lot <br /> POg'F'4rzWtcct4-,i( 5A(IT// /4/ <br /> Owner: � � (MlYO,Ct* 8 LTP&4; tQ Buyer: ChM C `J/k 1 774 <br /> A <br /> Address: ZdSzg RA126-EL t Ut RdtEo Address: <br /> ry � ' <br /> Phone: Phone: <br /> ,1 Oriainal Parcel Information <br /> Ad- <br /> Parcel ID#: 034— l5 ' — O Z— Z op Section 3 4�> lkiTownship + nge(X Lj0 <br /> Original Description(or attach copy): q � <br /> Current Zoning:�Floodplain Y/N: Wetlands Y/N: Lake/River Class: <br /> Name of Water Body: D e,S l� Shoreland Agreement/SIPS Y/N;_ V <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Information 1 <br /> Proposed New Legal Description and Parcel Size: 366,00 �P Br7L71C-1 I/ <br /> o F '{fit e so t4-{A w est 4 r to Yz SW Se 'vrl 30 't,Jns <br /> 37 iVoeAj Ra t4 e- �S lJes7LT1�K of Tri G" i6"1�` a9ts ast, t <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> r <br /> Proposed access to public road: <br /> m <br /> Proposed access to public waters to be provided Y/N: /V <br /> If yes,describe access: p+�I <br /> Signature of Owner: Date: <br /> Signature of Owner: Date: a d< (P o <br /> a <br /> c <br /> ➢ Does parcel meet Zoning Requirements? Yes No , <br /> z <br /> N <br /> ➢ Does parcel require a Survey? Yes No <br /> Permit application fees submitted? Amount$ �jD �-�p� ) Receipt# <br /> r 34econciles with Real Property ListerYes No Date: <br /> v <br /> 0 <br /> If not,explain: <br /> A <br /> n <br /> 0 <br /> �s <br /> a <br /> Applicatio Approved / De ied Reason for Denial: <br /> Land Use �7 Date <br />