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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 /> fD� J f Q F* b <br /> VI <br /> JV Owner: It'Y1 v'l t2 U N Buyer: D IAt9 gym e- s Rot- (AD/' •e-r W CD <br /> c CD <br /> Address: 7 /l, C leQ # ��S—Address: / S'G /ZOli) �!/-e-- n p <br /> t .vt ii)z. Scf'72_--- S/ 'ier-vi All" .-.87Z- N . <br /> � <br /> Phone: Phone: � w <br /> Original Parcel Information Q <br /> Tax ID#: Section Township Range <br /> Original Description(or attach copy): W 2-0 -- — X / '' . 2/8: <br /> O <br /> 4 <br /> it1 AW -Ex Gt) 20 ii-c — -x ' 32/g' <br /> V' <br /> Current Zoning: /9- loodplain Y/N: �r9 Wetlands Y/N: Vf--7 Lake/River Class: �. <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: 14 p <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: ? <br /> fb <br /> New Parcel Information " <br /> rto 47L CSC G 74/ �► <br /> Proposed New Legal Description and Parcel Size: o I <br /> �tb u/7. on, -/of' / Buj'fl� C21.)JA <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> !7 <br /> ,J�Y 7 -,1- 01^ / p/`l 1, <br /> Proposed access to public road: 7� �'I�l eGS Cowl fifes/ � <br /> Proposed access to public waters to be provided Y/N: / aec ,5 E <br /> W <br /> If yes, describe access: <br /> l °0 <br /> Signature of Owner: f ` Date: ( k .. <br /> Signature of Owner: Date: <br /> ..3 Fee Rec: <br /> ➢ Does parcel meet Zoning Requirements? Yes No x <br /> In Check#: <br /> w <br /> ➢ Does parcel require a Survey? Yes No m <br /> z CD <br /> v U ll UV <br /> Reconciles with Real Property Lister Yes No Date: n En m <br /> m f7 0 <br /> y <.3 co> m <br /> If not,explain: a W <br /> n <br /> oa tri _ <br /> • 3 w Application: • pproved / i enied Reason for Denial; P ' Ll u u^ <br /> m �------� <br /> Land Use:/c2m.4...._ <br /> Z� Date: o U <br /> ( /f zD�3 > <br /> / a <br /> b <br />