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pgrwv &Why ft by y Fee$ must accompany form): <br /> Burnett County Subdivision Permit/Survey Review Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> Application and/or PA <br /> }re-J�ppp�li/cattion Form Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner:JtFFRorL <br /> t y � r• Z CM ti/1 'guye: ro <br /> Address: Address: �y <br /> Q Q� / /f o <br /> Phone: "'�~ " 3- /n5 9+ Phone: <br /> a-y0-lb3`�`''S ri inalParceelInfforrmat' Q <br /> Parcel ID#: d7 Oath-p�'7O"Ib' 5 /✓40 Secti'on_,2_7 Township 'kiN Range 14,Y <br /> O <br /> Original Description tto__r attach copy'): 9 �Q 40 o/- <br /> e <br /> ya fated E Gf Q/fU'S G L• d2 <br /> Current Zoning: /"` Floodplain( Wetlands ON: Lake/RiverClass: / <br /> o Name of Water Body: II IGf. H/6 / -IIA Shorehmd Agreement/SIPS Y <br /> m Farmland Preservation Y*_Managed Forestry Law YR <br /> 0 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: d:51)-) <br /> Acres: • / <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> //�� <br /> Proposed access to public road: C . 1— <br /> m <br /> Proposed access to public waters to be provided Y45� <br /> If yes,describe access: <br /> Signature of Owner: Date: <br /> Signature of Owner: Date: 3 <br /> a <br /> p� <br /> e <br /> D Does parcel meet Zoning Requirements? Yes No � t� A-Q C'P- <br /> o ➢ Does parcel require a Survey? Yes No O K T t�irJdr` <br /> 00 D Permit application fees submitted? ❑ Amount$�' OD Receipt# <br /> p_ ❑ Reconciles with Real Property Lister Yes No Date: <br /> 0 <br /> If not,explain: <br /> 7d <br /> m <br /> n <br /> e <br /> Application: Approved / Denied Reason for Denial: <br /> Land Use: Date: <br />