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Fees <br /> ust accompany <br /> Burnett County Subdivision Permit Application Subdim onw/o Sur%ey��$50.00 <br /> and/or Pre-A Iication Form SunzyofRRusting Parcel: S50.00,1ot <br /> pP SubdivistonwiSurvee $200.00+S50.00/lot <br /> �n��Sfvvl<��s; ir7c <br /> Owner: S,, -t+ eK Buyer: <br /> Address _ Address: <br /> Phone: 5 /- �(� -� ?' I �o <br /> Phone: <br /> Orieinal Parcel Information <br /> ZTownship <br /> aa ` 6=Parcel ID#: 0�-D 2 4 " 2' �}� -it/�f'L)�j"2 Section �JRange <br /> Original Description(or attach copy): #f+n CA-e d <br /> z <br /> nn .� <br /> Current Zoning: 1( I r✓ {r <br /> 3 g: _Floodplain Y'/N: ti' Wetlands 1'!N:40 5 Lake/River Class: <br /> o Name of Water Body:-1� Shoreland Agreement/SIPS Y/N:_ V�_ (` <br /> U, <br /> Farmland Preservation Y/N: � Managed Forestry Law Y/N: J1tr�/i} <br /> New Parcel Information (�SlYN 02 -P, <br /> Vo <br /> 9.0--k <br /> Proposed New Legal Description and Parcel Size: 0.G i`e <br /> Lc,c�rI Le,ke <br /> U �o ���r z �,�,t t� t � a�st� <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 <br /> oad:Proposed access to public waters to be provided Y/N: )li <br /> If yes,describe access: <br /> Signature of Owner: F Date: tCj <br /> Signature of Owner: Date: c <br /> 0 <br /> Y Does parcel meet Zoning Requirements? Iles No - <br /> N � <br /> 4 i Does parcel require e a Survey? Yes IN70 <br /> ?t <br /> 30 Y+ Permit applicalion fees submilted'' 0(1 -1 mount f 1 1 r���� <br /> --- — — /� {{{ tiff <br /> ❑ Reconciles with Real Property Lister Yes No Date: JUN 10 2016 <br /> If not,explain: — -- <br /> X <br /> m <br /> -- ZONING <br /> Application: proved / enied Reason for Denial: <br /> Land Use: y�r�w. <br /> �---� r / Date: <br /> {+1 a� o F SG!^! `DY• c?,Yt et/ SDGI O pbq • <br />