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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 Subdivision w/Survey: S200.00+$50.00/lot <br /> Owner: Dale Bistram Buyer: b <br /> co <br /> Address: 3 11p IV Q i t.k S1 . Address: g• <br /> 2 <br /> (-3roinfsL7Vr' t wi 5iwt-to <br /> � 64 <br /> Phone: ,7 I J " l�(�1 - CEO JS Phone: <br /> Original Parcel Information <br /> b�— Cab 2 - 38 t <br /> Parcel ID#: 11 — I cl— 01 —OVO OIIOO�,/ Section ((7 Townshipaf� Range 14c. <br /> Original Description(or attach copy): Ltfc�►r I'1Pt''( et <br /> Cur nt Zoning: Floodplain Y/N: 4.. `.Wetlands Y/N: Yee-.,ake/River Class: l` <br /> r tl <br /> egName of Water Body: �DD / Shoreland Agreement/SIPS Y/N: f <br /> IT Farmland Preservation Y/N: Managed Forestry Law Y/N: T <br /> New Parcel Information r I1 l <br /> Proposed New Legal Description and Parcel Size: lli.e ��O 1/-T1 /`/ (7 a' 5 f " <br /> l - -1--11c, (11-io a rho att. (y (1 po,t I <br /> 1 Acres: <br /> (If parcel is to be surveyed,provide pr• ' t ary.ma . See at Bch•. fo el t 1 <br /> �] pQ ou PQ <br /> Proposed access to public road: `lip ' — ( I (A)`U j 70 Aci 0..) e f'itli1 S ega/puyy u <br /> Proposed access to public waters to be . 4 ql"!R/f v_ <br /> If yes,describe access: <br /> Signature of Owner: &•...x� /' / � .- Date: - (l g c' &y N <br /> Signature of Owner: Date: B <br /> a <br /> Does parcel meet Zoning Requirements? Yes No ro <br /> N i- Does parcel require a Survey? Yes No <br /> s <br /> ere Permit application fees submitted? 0 Amount$ Receipt# r <br /> r 0 Reconciles with Real Property Lister Yes No Date: 'l er°. If not,explain: <br /> a <br /> a <br /> vE <br /> PO eid$-120- 1 <br /> . . i ._...)° <br /> Application Approved / enied Reason for Denial: Burnett County <br /> Land Services Department <br /> Land Use: e . Date: 6®2&Z <br />