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1•ecs(must accompany torn): <br /> Burnett County Subdivision Permit application Subdivision w/o Survey: 550.00 � <br /> Survey of Existing Parcel: S50.00Aot <br /> rl.2r ire-Application Form Subdivision w/Survev: 5200.00+S50.00/lot <br /> ah <br /> a' ��G Address: —`� `1_ / I T�( t�A/ddress b �iUC�Cl�Q'1t kV k <br /> 1 � <br /> IPhode:L /n I _L' t ? � f"Qat€. �GcPhone: / /(� !! +1 <br /> _c — _ <br /> 1) 7-0 3y- ?-3'7"4 10 '-inal far efinformation <br /> ParceIID#: D'7 03`f-a 3i'!4 2/-5 OS UU43S`e o � Township 37"' Range <br /> Original Descri tion(or attach copy): LAa2 3 <br /> Current Zoning: /L o--- Floodpiaio%N: Wetlands(-": <br /> Lake/River Classification: —Name of Water Body: t i-ffle / rt <br /> Shoreland Agreemt or SIPSY Farmland Preservation Managed Forestry Law Y�P _ New <br /> Parcel Information <br /> Proposed New Legal Description and Parcel Sze: <br /> ------------------------- -- Acres: /, (4061, <br /> --- <br /> (If parcel is to be surveyed,prot,4Je preliminary map. See attached for preliminary map requirements.) <br /> 71"/e t <br /> Proposed access to public road: 1 r4 <br /> Proposed access to public waters to be provided <br /> If ves,describe access: <br /> Signature of Owner Date: <br /> 2 <br /> Signature of Owner: _ _ Date: a o <br /> ➢ Does parcel meet Zoning Requirements? Yes No n <br /> N <br /> ➢ Does parcel require a Survey? Yes No <br /> 00 <br /> Permit application fees submitted? ❑ Amount 3 Receipt# <br /> ❑ Reconciles with Real Property Lister —Yes No Date: <br /> c <br /> If not,explain: <br /> Lo — <br /> r1 <br /> Application: pproved enied Reason for Denial:__ <br /> Land Use: Date:_ — ZnNINC <br />