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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 /> • <br /> Owner Melvin Theisen Buyer d u <br /> 4 <br /> A P <br /> _" <br /> Address: 0 60 31Address: <br /> •N <br /> Phone: 816-805-3596 Phone: '� w <br /> .. . illik <br /> Original Parcel Information <br /> Tax ID#: 07-012-2-40-15-15-5 15-735-054000, Section 15 Township 40N Range 15W <br /> 053000,052000,051000 V.l <br /> Original Description(or attach copy): Lots 42-45 Thunderbird Add to W <br /> O <br /> 1 <br /> Current Zoning: PUD Floodplain YIN:N Wetlands Y/N: N Lake/River Class: <br /> Name of Water Body: N/A Shoreland Agreement/SIPS Y/N: C, <br /> Farmland Preservation Y/N: N Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: CSM to combine 4 Lots i <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> 5 <br /> Proposed access to public waters to be provided Y/N: � <br /> °Qo4 oiQ <br /> If yes,describe access: )3 /4 k)1 <br /> Signature of Owner! )// f,//l4 Date: Y-g <br /> Signature of Owner: Date: <br /> > Does parcel meet Zoning Requirements? Yes No N <br /> Fee :.�� <br /> c. Check <br /> #: 4497e<2 <br /> > Does parcel require a Survey? Yes No pi <br /> Reconciles with Real Property <br /> p rty Lister No Date: fa/5t9 3 8 <br /> y <br /> If not,explain- a <br /> 0 <br /> •e <br /> Applicatio I f pproved / 0 enied Reason for Denial: 0) <br /> m <br /> Lan se: Date: <br /> 4 7 zo Z-3 <br />