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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: S200.00+$50.00/lot <br /> r b <br /> Owner: A?f1 L 7) //oPI ENS Buyer: go ACI A. AasD E 1,0E- et <br /> r <br /> S10 /Do7 �(�2CLi< / 1°" F. x <br /> Address: 0,145 40 �`-�.L.�� �oAL7 Address: / <br /> auE-asr , car. /'oy A-Ds mu', s.�y33 <br /> Phone: / /J-3 8/" g?3 0 Phone: ‘$/- ' !J #"57 I�J <br /> t <br /> / Original Parcel Information ,, ' <br /> Tax ID#: 6v4"/p.Ga, �p AS3 Section 3. Township.L�, Range /5 `-' <br /> Original Description(or attach copy): <br /> eo <br /> Current Zoning: Floodplain Y/N: Wetlands Y/N: Lake/River Class- t <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: E <br /> New Parcel Information <br /> ,_. <br /> Proposed New Legal Description and Parcel Size: <br /> 3 ,,, <br /> Acres. l`o <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 /> O- <br /> If yes,describe access: <br /> -\/( <br /> Signature of Owner: <br /> j✓`5/ Date• r `� <br /> W <br /> Signature of Owner: Date: <br /> Fee Rec: SD, <br /> ➢ Does parcel meet Zoning Requirements? Yes No • m Check#: /1 Z.7 <br /> ➢ Does parcel require a Survey? Yes No 0 <br /> r <br /> 9 <br /> gi <br /> Reconciles with Real Property Lister No Date: 'iO/3A 3 a S <br /> v3 <br /> If not,explain: <br /> 0 <br /> K <br /> Applicatiot(Approv Denied Reason for Denial. 0 <br /> Land Use: //�/J� Date: <br /> // C/" &z H <br />