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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+$50.00/lot <br /> iv <br /> QQ�/i� H A <br /> Owner: �' G � Buyer: z, <br /> �* <br /> 3) 7..S 5 146 L , o <br /> Address: \ j Address: <br /> {S A'13i/Ey t-'& _. 5`1 3 C <br /> Phone: 5/J74._ 70 Phone: qt A <br /> Original Parcel Information b D� <br /> Tax ID#: /_ /2 Section�Z Township 4/ Range /-5--- <br /> O <br /> Original Description(or attach copy): tz <br /> x K <br /> y <br /> 5 JZ, <br /> m <br /> o <br /> / v <br /> Current Zoning: I Floodplain Y/N: N`-') Wetlands Y/N: y Lake/River Class: e! r <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: � y N <br /> EA <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: l › <br /> 0 <br /> New Parcel Information j e <br /> Proposed New Legal Description and Parcel Size: 5`P�/'7 ``' v nr�LS F •1 <br /> c/vk '2!9/).0i71 --r-'7 A et :4 7 /5 r}c Y$ Teo /Aid 1/r or c <br /> J v%� Ciif 5/ •7c' £9$ / lec-q// b�,i7/7 // ' 75 a <br /> i !'cAcres• b <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: E <br /> Proposed access to public waters to be provided Y/N: Ff <br /> If yes,describe access: Ly <br /> Signature of Owner: , /—.__ /- .' 4-2 Date: •''''/2 -- 1-`y <br /> Signature of Owner: Date: <br /> Fee Rec: <br /> co <br /> ➢ Does parcel meet Zoning Requirements? Yes No Check#: 3 <br /> ➢ Does parcel require a Survey? Yes No <br /> Reconciles with Real Property Lister Yes No Date: CaW_`207-,1 r <br /> n In <br /> If not,explain: CD W <br /> m ca o FM <br /> 0 o ti 0 <br /> m c tv <br /> Applicati : Approved / enied Reason for Denial. w <br /> 3 nn1 <br /> Land Use. ) Date: .l u U <br />