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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Some:,: $50.00 <br /> Survey of Existing Par el: $50.00/lot <br /> ,� Tand/orPre-Application Form Subdivision w/Survey $200.00+$50.00/lot <br /> Owner: �gXA /egt2Dt✓N Buyer. L .J /` e(��t+J/� •o <br /> P� aGC �x Address 11��eL^6 <br /> Address: S - <br /> Phone: S—Ooa 6(pG Phone: V-6_3t —32!e— D D O , <br /> Original Parcel Information _-Z <br /> Parcel [D#: a ! #-,J✓4Vpr 5SE4y Section '3 0 Township r3X nge f 4 Ljv <br /> O <br /> Original Description(or attach copy): S��' 'S/> Sr/D✓3Q <br /> m <br /> L �y <br /> s� a �E�y sacr11,�✓3 b T3a,��/._52,��uu a� r�� � I�I <br /> Current Zoning: Floodplain Y/N:--V Wetlands Y/N:_ Lake/River CI ss: VA <br /> D Name of Water Body: NA• Shoreland Agreement/SIPS Y/N: <br /> •o <br /> A, Farmland Preservation YIN: Jif Managed Forestry Law Y/N: /V <br /> (p <br /> New Parcel Information _ 3 <br /> Proposed New Legal Description and Parcel Size: of SLAPS&A pl'`S�CTIop'3'� 39X) <br /> 5lf 6,C S�2� p -srznp✓3a ayrJ,t°/s <br /> Acres: P t'S 3z> /Z <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) V0 <br /> Proposed access to public road: IV / O <br /> Proposed access to public waters to be provided Y/N: N f <br /> If yes,describe access: �� SZ1I <br /> (' r1 � yyoC3 <br /> Signature of Owner: rX�/�-'4a- .�2az.-I✓ Date: �Jd <br /> Signature of Owner: Date: <br /> e <br /> Does parcel meet Zoning Requirements? Yes No 5 �10 z <br /> it <br /> ➢ Does parcel require a Survey? Yes No • O <br /> °Q ➢ Permit application fees submitted? 0 Amount$ Receipt# O <br /> t Reconciles with Real Property Lister Yes No Date: <br /> m <br /> atjy <br /> � If not,explain: � r <br /> o r <br /> � I <br /> a r <br /> y <br /> I V <br /> Applicat' n: Approved / Denied Reason for Denial: r <br /> Date: <br /> Land Use: J dSd o O <br /> O <br />