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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 /> �' / (/� C = <br /> //fj�� <br /> Owner: /�l0/`/"f/ O Buyer: FD 3 <br /> d = <br /> 3� - 5/8r2-- Address: f° ° <br /> 4/4/..e.er (A)'X 31400/ 1..... <br /> Address: <br /> CA <br /> „` C <br /> N <br /> W <br /> Phone: Phone: u ' <br /> �n I Original Parcel Information / <br /> Tax ID#: ' 3/ 1 /a Section I__ Township Range ( 6 W <br /> Original Description(or attach copy): NO -N 7_ 5L -A-5 <br /> E. <br /> 4 <br /> a <br /> A <br /> Current Zoning: I7/l-2,Floodplain Y/N,1� Wetlands Y/N: /1 Lake/River Class; /f/ it <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 /> Proposed New Legal D scriptio and Parcel Size: a/0/f.._ /j't''1�1 ' ce_. <br /> f,4q , Dl ec l- <br /> /0 T S ail a/ 7 0 ©a 71%7s Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) yY <br /> Proposed access to public road: k <br /> C <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: W W <br /> N, <br /> Signature of Owner: Date: v <br /> Signature of Owner: Date: <br /> -i Fee Rec: 10 Z.SO.� <br /> ➢ Does parcel meet Zoning Requirements? Yes No c Check#: /l;V 7 <br /> ➢ Does parcel require a Survey? Yes No °m <br /> z 1 Q <br /> o J <br /> Reconciles with Real Property Lister Yes No Date: a `,,, <br /> C4fiii <br /> co w <br /> If not,explain: > 0 Z <br /> 'T <br /> N <br /> z Qo 0 <br /> o <br /> Application. rove• Denied Reason for Denial: P 3 <br /> Land Use: ��" Date: <br /> G�3�zo z3 f <br /> G� <br /> .b G LcJ <br /> F/A4 a Pled- /}f f lib y 4�'1 Use_ <br /> Cw1 ,.n e e_ e4 4/6720 z,3 <br />