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Fees(nmst accompany torn)_ <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> and/or Pre-A lieation Form Survey of Existing Parcel: $50.00.!lot <br /> ph Subdivisionw/Survev: $200.00+$50.00/lot <br /> Owner: See Attached narrative for list of Buyer: <br /> owners €vo ve m is project, <br /> Address: <br /> Address: <br /> [ Vernon & LalVern Johnsen project � z <br /> 0 <br /> Phone: Phone: <br /> Orieinal Parcel information <br /> R <br /> Parcel ID#: See'' Attached Parcel Listings Section 4 Township 400 Range 14VV <br /> O <br /> Original Description(or attach copy): s <br /> A <br /> A <br /> RR-2 N <br /> b Current Zoning: Floodplain Y/N: Wetlands Y/N: N Lake/River Class: <br /> Fish Lake <br /> e Name of Water Body: Shoreland Agreement/SIPS Y/N- n �I <br /> '. Farmland Preservation Y/N: Managed Forestry Law Y/N: NT <br /> New Parcel Information ] <br /> Proposed New Legal Description and Parcel Size: See Attached CSM V, "'�7 Z r/Q <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Direct acce=ss to CTN hi C <br /> m <br /> Proposed access to public waters to be provided Y/N: N <br /> If yes,describe access: _N <br /> Signature of Owner: Note parcel owners signed map Date: <br /> for easement dedication <br /> Signature of Owner: Date: e <br /> ➢ Does parcel meet Zoning Requirements? Yes No S <br /> m <br /> N <br /> � ➢ Does parcel require a Survey? Yes No <br /> r' ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> r, ❑ Reconciles with Real Property Lister Yes No Date: <br /> w <br /> P <br /> ° If not,explain: <br /> rgn <br /> UVWUP <br /> 0 <br /> CL <br /> N <br /> ApplicationA proved / enied Reason for Denial: FEB .� 206 <br /> Land Use: D.t:,-•_ UN <br /> G- <br />