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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 rMa�p Review Form Subdivision w/Survey: $200.00+$50.00/lot <br /> / /i <br /> Owner: !-i'e-fil'I =I N iP �G�.e L. Bu er: . 4'/--f� el i <br /> C <br /> Address: G4 S t.LE: �tfcAddress: // l c <br /> t(; .I-+ (fio ',- Al .- / I LA CA <br /> CA <br /> Phone: ( i c 5 0 ( — to 0 S I Phone: /( <br /> p <br /> 16 <br /> Original Parcel Information <br /> 6Vi ft 67/ � /0 1f0 �` <br /> Tax ID#: / Section Township Range <br /> C <br /> Original escription(or attach copy): 249/S 2.-,9 f 2 ae, is a-414-` ij 74 . <br /> 1 x r w <br /> 0 <br /> m <br /> a <br /> 0 <br /> Current Zoning: PUPFloodplain Y/N: Wetlands Y/N: Lake/River Class. z ei <br /> 7" <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> Cr <br /> V) <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: ,a, <br /> o <br /> New Parcel Information // / Ic <br /> i <br /> Proposed New Legal Description and Parcel Size: GSAA 7t0 C_O1A\ U«C� /�qr'�/`5 <br /> / tr <br /> tt <br /> < <br /> d i <br /> Acres: b <br /> Y(If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) I <br /> Proposed access to public road: d <br /> Proposed access to public waters to be provided Y/N: % <br /> If yes,describe access: ' <br /> Signature of Owner: - — e"""--- g:;: Date: i ' ZS-Zd <br /> Signature of Owner: C� , �Z L6 Date: a "2- )OZ <br /> \ Fee Rec: 522,6° <br /> ➢ Does parcel meet Zoning Requirements. es No <br /> Check#: 7 Z 7 Z- <br /> ➢ Does parcel require a Survey? Yes No <br /> Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> Application Approved / ii enied Reason for Denial- <br /> Land Use: Date: <br /> am-' //:V&7 2. <br />