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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 Subdivisionw/Survey: $200.00+$50.00/lot <br /> 0.4 iv <br /> cA <br /> Owner: Z a V l ck e r ke S Buyer: = -I <br /> Address: 2 ! ce ! I S A rrt uJ Dr- Address: ° P <br /> 7-4Lc.cO 6 6 eJ) tAJ I S t/0) G c) <br /> A <br /> Phone: 7 le 3 -�c 0 � - y� 6 6 Phone: � <br /> Original Parcel Information SU ^C <br /> Tax ID#: / 6 Z. 9 7 Section 3 1 Township__ _(Range / V <br /> Original Description(or attach copy): $ -e e Ta )C .Z4 a e n-)-e a 6 a <br /> \ i <br /> n5 r <br /> Current Zoning: � Floodplain YIN: c� Wetlands Y : Iti_ Lake/River Class• rz <br /> , <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> v) 1 • <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: Y <br /> 0 <br /> New Parcel Information z <br /> r <br /> Proposed New Legal Description and Parcel Size: My >-al d 4 4 I 'D 'J 1.5 .6 a <br /> ri <br /> a v •e_ w a ?_ a aC. re ? a ✓sCC / S d <br /> CA <br /> .S P /> '& E bi.) <br /> Acres: <br /> y <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: ty <br /> Proposed access to public waters to be provided Y/N: -- <br /> If yes,describe access: �J <br /> Signature of Owner: Date: 7— 18' . 2- 51 <br /> Signature of Owner: Date: <br /> Fee Rec: <br /> Does parcel meet Zoning Requirements? Yes No Check#: <br /> Does parcel require a Survey? Yes No <br /> 1�J <br /> Reconciles with Real Property Lister a, No Date: 7/23/2O2y a <br /> m co _ s <br /> If not,explain: Z B r— <br /> m.a r.,o N Lid <br /> a CI <br /> CD a a IV <br /> Application Approved / e • eason for Denial. 3 <br /> Land Use: Date: 7/2 37ZV <br /> I Y1u5i- lNG`Ude- GCCe5S +0 Ci cogCie <br />