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Fees(must accompany forth): <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/Survev: $200.00+$50.00/lot <br /> '�etv/ve�A I Fri C ks dw + �n I 5R op b <br /> Owner: p I Buyer: �Y�/� 'F-Ir�tch¢�l� SAA�rcl '3 <br /> Address: �1P I !5 Old 35 Address: c <br /> Wr 5y893 CSW <br /> CC>' w <br /> Phone: i 5- 6�e�D- �63 Phone: J <br /> OrieinalParcel Information <br /> a OGO -o,loOp <br /> Parcel ID#: 01 (Q - 3LI/5-63 —/ (3 u Sectionp?� g <br /> IS Towoshi Range � <br /> Original Description(or attach copy): W SSE T Y CSS V r) P F& <br /> 3(�7' >9a A <br /> J <br /> Current Zoning: Floodplai6Y N <br /> 3 : Wetland Y N: Lake/River Class. <br /> ��r+�k roo <br /> ,D Name of Water Body: Shoreland Agreement/SIPS <br /> 9 <br /> m Farmland Preservation Y(jN:> Managed Forestry Law.Y <br /> New Parcel Information ! r <br /> Proposed New Legal Description and Parcel Size: See ��Gh� <br /> Acres:_ )0 Ac tcS <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) C <br /> 1 r m <br /> Proposed access to public road, EA'�fne/`- 1 /3T f!�ec Orc / p <br /> Proposed access to public waters to be provide�Y N: I P, er7: nr, � �l o�Ja,4 <br /> If yes,describe access: <br /> 7 �� � 3 <br /> Signature of Owner: Date: -.2o <br /> Signature <br /> Signature of Owner: Date: <br /> A <br /> �( u <br /> ➢ Does parcel meet Zoning Requirements? Yes l No <br /> c CY <br /> ➢ Does parcel require a Survey? Yes No _ I <br /> m ` <br /> as ➢ Permit application fees submitted? d( Amount$ IReceipt# <br /> Reconciles with Real Property Lister I` es No Date: I •7 I ! I I w <br /> r, itt"---11i U <br /> � If not,explain: Cj I <br /> ° Applicatio Approv / enie eason for Denial: O i <br /> Land Use: ! /3 O <br /> Date: <br />