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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 /> 1-1 cn <br /> b <br /> Owner: /v!Z. // ' 74 C---' Buyer: ffl @ <br /> C <br /> 5-g'. Z <br /> Address: /32.- - <br /> S Address: e° <br /> /9wr 1.0. . $ -yoo/ \ cA <br /> cA <br /> N `J <br /> Phone: Phone: w <br /> Original Parcel Information <br /> Tax ID#: 3 / <br /> 6 --�— l z-3 ' 7 Section 3 3 Township 3 9 Range / w <br /> / / �- <br /> Original Description(or attach copy): /(/ -NE �L - N, <br /> O <br /> a <br /> n <br /> Current Zoning: n 4- loodplain Y/N: ,V C Wetlands Y/N: /lie Lake/River Class: <br /> Name of Water Body: iti/i/Y. Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Informattiion Propose N egal Description and Parcel Size: C u N T7 Pc://--- Act <br /> /1ewa e-- 7 etrgc-Q_____ <br /> nI) a 5 / G©�s / fo /9 q4d o mu71-471- <br /> I'(� S Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) y➢ <br /> X <br /> Proposed access to public road: <br /> -r C <br /> Proposed access to public waters to be provided Y/N: x <br /> ti <br /> If yes,describe access: W W <br /> Signature of Owner: SC e- a 7qciAel e.v--\a►'j Date: J V <br /> Signature of Owner: Date: O <br /> H Fee Rec: /Z 5Di a� <br /> ➢ Does parcel meet Zoning Requirements? Yes No rA s Check#: 3 I <br /> ➢ Does parcel require a Survey? Yes Norri <br /> r <br /> a <br /> z <br /> drri Q <br /> Reconciles with Real Property Lister Yes No Date: (7 s) 511 <br /> re a A <br /> cn 0)En <br /> If not,explain. 2 ? 7 <br /> o om NO <br /> Z CD <br /> Ro c c <br /> Application: pprov / Denied son for Denial: 0 V <br /> Land Use: Date: /00e---,..7 r'2:1 I CA, <br /> TA, i s e. p ivl i kt +'/�/�J' /0/q f -�r'' N/ c 7rrace- �L <br />