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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: $200.00+$50.00/lot <br /> �+ / y b <br /> Owner: t? Ar 0�`/ 9 4�d /�s b'J Buyer:��L)t/ P /7Lit SW*I)ter d i <br /> > j 51 o�.s ae.�Tii / ST ST t <br /> A 7eh ('� �/ G��'4a Address: It <br /> e o <br /> Address: <br /> 511/ <br /> Phone: . )J ''Ji'l -ice J a Phone: 11 3r 7 /0 '5 3 7S <br /> // � 1 Original Parcel Information <br /> c. <br /> Tax ID#: 0DLOL0 0 J (,05 3 Section Township 4 O Range <br /> Original Description(or attach copy): <br /> A <br /> :7 <br /> Current Zoning: Floodplain Y/N: Wetlands YIN: 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: <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: C <br /> If yes,describe access: i <br /> Signature of Owner: Date: _�' V "t <br /> Signature of Owne . 11- Date: o 'Z i Zd Z Z <br /> Fee Rec: <br /> ➢ Does parcel meet Zoning Requirements? Yes No gt. Check#: <br /> ➢ Does parcel require a Survey? Yes No pi <br /> a <br /> 6 <br /> Reconciles with Real Property Lister Yes No Date: n <br /> w <br /> If not,explain: <br /> 0 <br /> r! <br /> Application: Approved / Denied Reason for Denial: P <br /> Land Use: Date: 6 <br />