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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: 550.00 <br /> Survey of Existing Parcel: S50.00/lot <br /> and/or Pre-Application Form or Map Review Form Subdivision w/Survey: S200.00+SS0.00/lot <br /> Owner:--- ' \V-1(j-S (l AP- Buyer: g g, <br /> Address: Cc k,'_ t Address: fD • <br /> -1 4s6 Uol , S-i O <br /> t ,, l - -p, �•-7 W N <br /> Phone: `� � 1,� 1�� ( Phone: I f. N <br /> G <br /> � <br /> Original Parcel Information <br /> �Tax ID#: 1 1 1 j+ Section ' Township 1.16_112ange V9 <br /> Original Description (or attach copy): -e... L1. `c.- 3 cl. (2...os 1.6:\ N E N <br /> O <br /> z <br /> Current Zoning: Rloodplain Y/N: N Wetlands YIN: A) Lake/River Class: ti V <br /> Name of Water Body: N //1- Shoreland Agreement/SIPS Y/N: Nv <br /> Farmland Preservation Y/N: All0 Managed Forestry Law YIN: ,it/z) <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: S OA- CU..wt-.-k tb • -1 0..6 L <br /> Ili <br /> ?('�iv�1-� t W\� GLc-CSC SS U; 1'a. 09' _Cj y[_s �� �`iN <br /> RQ <br /> Acres: <br /> , <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) ,a <br /> Proposed access to public road: ��.S �y�,,XYNI5 Vop� <br /> { p <br /> Proposed access to public waters to be provided l'1N: `v ' xt <br /> If yes, describe access: <br /> Signature of Owner: 6-'1---•'f _ Date: /4) fi 9I` 3 <br /> Signature of Owner: Date: <br /> Fee Rec: DD cP.J <br /> y Does parcel meet Zoning Requirements? Yes No <br /> s Check#: 4o1Z2 <br /> Does parcel require a Survey? Yes A <br /> z <br /> Jl j <br /> Reconciles with Real Property Lister ( Yes No Date: (,O iTh f 20-3 7. <br /> s a C7 U till <br /> CD C <br /> 0 <br /> If not,explain: T "•3 <br /> po r✓ c1 <br /> - m C N.) c4 <br /> N <br /> Applicatio Approved / 0 se nied Reason for Denial: w <br /> ITH <br /> Land y Date: 3 <br /> /o z1 zo z 3 �� �J <br /> s <br />