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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 /> b <br /> Owner: / ' u .:Zeme Ve� / ( "/a uyer: g g <br /> Iv T <br /> Address: Address: <br /> C <br /> N <br /> Phone: Phone: IJ ce <br /> 0 <br /> Original/ Parcel Information ,✓ �v PZ-) <br /> Tax ID#: 3 636 Z -/--- 36'j103 Section 3.7 Township L� Range �— <br /> Original Description(or attach copy): Ce / f' G 5 v 0/ a? <br /> I z9 0 <br /> a <br /> la <br /> ,/ <br /> Current Zoning: �Q—/Floodplain Y/N: � Wetlands Y/N: V Lake/River Class: �" <br /> il- <br /> am, <br /> k... <br /> Name of Water Body: �o /g� t d/ /L� Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> V <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: R e VI s /O d1 D{ 6 s` " / i <br /> Mar2 a 0 Uo I - ?�9 eel y Zq'D <br /> Acres: ' <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) y <br /> Proposed access to public road: 7 - Y <br /> k <br /> d <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: e e <br /> crty-► ,, <br /> Signature of Owner: Date: <br /> Signature of Owner: Date: <br /> -i Fee Rec: $ 'o� <br /> ➢ Does parcel meet Zoning Requirements? Yes No z <br /> Check#: .4 8' <br /> ➢ Does parcel require a Survey? Yes No d <br /> r <br /> z Jl J <br /> o <br /> r i— <br /> a d uul <br /> Reconciles with Real Property Lister Yes No Date: <br /> a CD <br /> rri co a) c° Ill <br /> 3 <br /> If not,explain: > 5» t.s �I <br /> n <br /> °z o C N o <br /> z.K O <br /> Applicatio . Approved / 1 •nie�ason for Denial: // rr m <br /> Gild <br /> Land Use: �iLu� �^�" — Date: °/ ?/00L3 rn rn z <br /> { e,llisiD 6,7 eino✓' C5 <br /> 3 <br />