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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 /> / b <br /> / / _ / r I Ad/ <br /> C �tOwner: ///l r6 a- VV Ct ! ve (-S6'� Buyer: (,4-41 i w 3 <br /> C 2 <br /> Address: ,�jo2 d 0 6.41), ° ZG64, ,64 ddxess: ° o <br /> >f,iQ- . ,V 0�v 1. C <br /> Phone: 76,.3— -7_L,... — 6 3..5 2 Phone: .-s.2 <br /> 2 n Original Parcel Information <br /> �Tax ID#: A J �J 24 31p 1 Sectio 'S'J Township 3g Range / e <br /> Original Description (or attach copy): 0 <br /> o <br /> P r. <br /> Current Zoning: A2 "'JloodplainY/N: T Wetlands Y/N: Y Lake/River Class ; <br /> Name of Water Body: QdC 1.Ct l(,l/ Shoreland Agreement/SIPS Y/N: <br /> • <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Information L / <br /> Proposed New Legal Description and Parcel Size: PLLOh �rr,GJL � r ' 4A I <br /> ire . Y <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: d <br /> If yes, describe access: >u <br /> AV <br /> w <br /> Signature of Owner: !��> � �'��"' Date: ���/Z j , <br /> Signature of Owner: Date: <br /> Does parcel meet Zoning Requirements? Yes No R D D c-1«. x Fee Rec: .3 c,o <br /> ➢ W /5D3 : $33 ' --, Check#:/9 Da_ <br /> ➢ Does parcel require a Survey? Yes Norrl <br /> r <br /> z <br /> z <br /> 0 <br /> rn <br /> Reconciles with Real Property Lister Yes No Date: n <br /> If not,explain: y <br /> m <br /> O <br /> z <br /> r <br /> Applicatio Approved / 1 enied Reason for Denial- <br /> m <br /> Land Use: Date: <br /> 0 <br />