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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+$50.00/lot <br /> Owner: K+vJog L..,ce LSk.-1- -1Nlo14-It 0 rg yer: i <br /> Address: 2°J' (09 D Gas ko Tr- b ( Address: <br /> P <br /> k' 6\\ k-e.. Wk 54-Gil c <br /> 50 <br /> Phone: Phone: <br /> 1 <br /> TA,, O Orit final Parcel Information O <br /> Parcel ID#: 32* 1 Section 11 Township 38 Range 1 4 <br /> O <br /> I <br /> Original Description(or attach copy): \:5 CS M ,a `, t 1 b. CACan.L k op b•' a <br /> Current Zoning: A Floodplain YIN: /" Wetlands Y/N: N Lake/River Class: N <br /> 1— <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> ma <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N:a <br /> a <br /> New Parcel Informationef- <br /> Proposed New Legal Description and Parcel Size: L4. I -,-..-- CS M <br /> Acres: 5. 00 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) "= <br /> a <br /> eD <br /> Proposed access to public road: 84560 t(N • � w <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: j <br /> Signature of Owner: -i7/ .(l Date: / -- -0 7 1 2 <br /> Signature of Owner: Date:➢ Does parcel meet Zoning Requirements? Yes No /0 Zrrr//3 v <br /> 1 <br /> c ➢ Does parcel require a Survey? Yes No W <br /> a do N <br /> ao Permit application fees submitted? ❑ Amount$ ,�-/ Receipt# G1 <br /> \� <br /> 0 Reconciles with Real Property Lister Yes No Date: G1 <br /> t' ti <br /> 20 If not,explain: <br /> a <br /> a. <br /> 7`i <br /> n <br /> 0 <br /> c. Application: Approved 21enied Reason for Denial: <br /> H <br /> Land Use: Date: <br />