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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 /> C% a <br /> Iv <br /> N Buyer: co g <br /> ^* <br /> m <br /> Address: Address: :°. <br /> Phone: Phone: w <br /> N C <br /> Original Parcel Information O -- <br /> 2 2 <br /> Tax ID#: / 6 �/� Section_L Township,, ange / . cN <br /> Original Description(or Attach con) Z-er7 //Z G 5At4 5-2 4a <br /> vo / ?-9 ry , 3f.74 <br /> o <br /> a <br /> A <br /> Current Zoning: Floodplain Y/N: Wetlands Y/N: Lake/River Class. II <br /> M <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> p <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: /V eA....0 C 5,14 ' `'e....42-- <br /> c i # 5-2/Z Vo c/, 9 /,/ 3 iLS <br /> (94/) c4r /s Grc4/ 1:7 1.3 a 4N/;o% <br /> is /" ," G/ <br /> ye Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> C <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> Signature of Owner: Date: <br /> Signature of Owner: Date: <br /> ➢ Does parcel meet Zoning Requirements? Yes No s Fee Rec: /V/�c Check#: ,----- <br /> v, <br /> > Does parcel require a Survey? Yes No m <br /> a <br /> z I— 1 � <br /> u, <br /> m r- <br /> 70 fill <br /> Reconciles with Real Property Lister Yes No Date: a `_ <br /> rrri n aW a <br /> c <br /> If not,explain: a m Z <br /> o O o co ca <br /> Applicatio Approved Denied Re son for Deni I: rn 3.. C ^� <br /> ► H fp�Q �4N�/ , m ll 111J <br /> Land se: M i ' A� 4 4.4d 1 ate: m <br /> �9Zoz3 J <br /> K <br />