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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 tv/Survey: $200.00+$50.00/lot <br /> y co <br /> Owner: CM C OY1 C OL Buyer: F i, <br /> Address: 301 J La 21, ea Address: <br /> e o <br /> nbtdry tAi 1 53a <br /> Phone: Phone: <br /> I <br /> Original Parcel Information Iv ,\D <br /> Tax ID#: 2J 230 Section 2 8 Townshipti Range % 4- N Q <br /> Original Description(or attach copy): LO T 13, C. ' i ,.. 1.756 , Vol 9 f, Kt a o <br /> n <br /> Current Zoning: Floodplain YIN: Wetlands Y/N: Lake/River Class: <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: Zi L.ci L_ <br /> PP ) � <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 /> Proposed access to public waters to be provided Y/N: E <br /> If yes,describe access: c <br /> CY r7 <br /> Signature of Owner. ,..A.A., f 14 2 2-Date: N XI <br /> Signature of Owner: Date: <br /> 00 <br /> Does parcel meet Zoning Requirements? Yes No �#. 17 Y?i Fee Rec: 3 . <br /> o <br /> 2 i2 Check#�:: <br /> 3= Does parcel require a Survey? Yes No A ✓3. � 9 r9 17 { t <br /> a <br /> z t <br /> m <br /> Reconciles with Real Property Lister No Date: 9I12./2.2. < soNil <br /> Fi a r� <br /> If not,explain: v Z mmp 0 <br /> 0 OAa co <br /> n 0b to <br /> Application:// •pproved Denied Reason forfo Denial. x 3•` N <br /> Land Use: 7�' ie,ZmK� �r Z Z �� Date: sr 0 <br /> % ' fill <br /> ------) o /3 ZOZ �L <br />