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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: g �' 71 Buyer: A <br /> t/ d <br /> Address: 2 �T 7 O//��� Address. n o <br /> -, ,,, <br /> N <br /> Phone: Phone: A <br /> Original Parcel Information fW <br /> Tax ID#: ,J O 7.3 t 3 T l Section -_,L.1 Township Range /C 0 <br /> Original Description(or attach copy): A <br /> y <br /> N <br /> 5 <br /> m <br /> z r, <br /> Current Zoning: A R eFloodplain YIN: , Wetlands Y/N: Lake/River Class. w <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: y <br /> V) <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: > l, <br /> o <br /> New Parcel Information z <br /> �� / / 404 F <br /> Proposed New LegalDescription and Parcel Size: ��/t^�!l r/ 4 vitopA m i�. <br /> G <br /> y <br /> Acres: - <br /> b <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: d <br /> Proposed access to public waters to be provided Y/N: C.11 CY\ 0 <br /> If yes,describe access: O 0 <br /> Signature of Owner: Date: ^t. 41 <br /> Signature of Owner: Date: <br /> Fee Rec: 94949 <br /> ➢ Does parcel meet Zoning Requirements? Yes No ? <br /> Check#: 6 O 9Y3 <br /> ➢ Does parcel require a Survey? Yes No <br /> Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: r <br /> piqf p►ved a by <br /> Applicati : Approved / Denied Reason for Denial. CaptA.A MI' I l �� <br /> Land Use: Date: Oh (/// 2r <br />