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Fees(must accompany torm): <br /> �4 Burnett County Subdivision Permit Application Subdivision wio Survey: $50.00 <br /> �j � Pre-A lieation Form Survey of Existing Parcel: $50.00i7ot <br /> PP Subdivision w/Survev: $200.00+$50.00/lot <br /> �3 �.t•lrlt <br /> R 60 1 <br /> A <br /> riqO7Address:5 V30 y I— k%NID/t/ PT/66 d //D CUUe�d /Lp2 3 <br /> dress: <br /> Phode*z 1,W81 Li-17 ,e tra44 ,, Phone: l.U7-5 1-tMe/le 1 / &'e <br /> -7 -7 rifinal arcef'Information <br /> � <br /> 3�-/f- 0?/-5 Dv oo l-03y-3- --0 ztocYsa <br /> ParcelID#: 07-d y a-37-/� 2/-5 0"S UO63�eccttion Township 37�Range <br /> O <br /> Original Descri tion(or attach copy): sa .3 � <br /> aT -741 le /t Ptll� --- <br /> n _ _ <br /> Current Zoning: Floodplai6N: Wetlands(JI: Y _ <br /> Lake/River Classification: Name of Water Body: �E 7 r6t <br /> Shoreland Agreemt or SIPSFarmland Preservation '6Managed Forestry Law Y* <br /> New Parcel Inforrmation a <br /> Proposer!New Legal Description and Parcel Size: <br /> Acres: / tP <br /> (Uparte't is co be surveyed,provide preliminary map. See <br /> attached for preliminary map requirements) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided 't% <br /> If ves, describe access: <br /> 00 <br /> Signature of Owner: Date: <br /> Signature of Owner: Date: n <br /> e r Does parcel meet Zoning Requirements? Yes No <br /> oa I <br /> a <br /> F <br /> Doesparcel require a Jurvev? Yes No <br /> Permit application fees submitted? 0 Amount$ Recerp!4 <br /> C: Rt-conriles with Real Property Lister Yes No Date=-- -- Ya _-— --- <br /> i If not,ebp:ain: ---- <br /> 1r}7 <br /> Applicatan: proved / Denied Reason for Denial: _ N—� V—T� <br /> Land Usna�%��"" _—. 6/�g �S — Date:_— <br />