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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 /> /� Nj'4 Buyer: e <br /> Owner: m <br /> C <br /> Address: Address:. CD <br /> z <br /> Phone: Phone: <br /> o <br /> Original Parcel Information <br /> Tax ID#: (1 9/ r Section Township 3 p—Range 1(-o <br /> Original Description(or attach copy): 5Fe- ,4�-,9-c ei beC. No • <br /> Lf7HyoZ- C <br /> e <br /> CD <br /> Ili <br /> Current Zoning: IL 3 Floodplain Y/N: Wetlands Y/N: y Lake/River Class• lo <br /> I <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Information <br /> i <br /> Proposed New Legal Description and Parcel Size: 5E 457l�t-CM't CS/-7 <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) ,.3 <br /> a <br /> Proposed access to public road: e&re-K.Sc),-1 �Q.o,4.'D <br /> C <br /> Proposed access to public waters to be provided Y/N: f <br /> If yes,describe access: <br /> Signature of Owner: Date: fa / i <br /> Signature of Owner: Date: <br /> y Fee Rec: ©0�0 <br /> ➢ Does parcel meet Zoning Requirements? Yes No Check#: CcrSf/) <br /> ➢ Does parcel require a Survey? Yes No tv <br /> r <br /> > <br /> z , __ <br /> o �1 1 I <br /> Reconciles with Real Property Lister Yes No Date: rn <br /> a <br /> H a, W IMI <br /> V <br /> If not,explain: <br /> " CD x MI <br /> co '+u <br /> 0 y <br /> Applicatioiproved / �enied Reason for Denial: R`( i <br /> l p m `CD �lll <br /> g CO <br /> Land U • Date: �/ / �0 m <br /> > �J <br />