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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/Survev: $200.00+550.00/lot <br /> Owner: Sc c''1 0,t1)/Jtt v n e-c4c- Buyer: .y <br /> �.3 t^G ! Scr,k-D i t / 3 <br /> Address: c< nac Address: r; <br /> `CG r..nCSGp7b�-� �V/ i `�3 yt� 0 <br /> 7 <br /> Phone: ! l S- �� /�- ��c Z S <br /> Phone: Q) <br /> Orieinal Parcel Information d <br /> Parcel ID#: C `1C - 36 34 -N 000 Section 3,� Township 71 Range <br /> Original Description(or attach copy): NAA - S 6- " N w <br /> • <br /> 'a <br /> Current Zoning: I 3 Floodplain Y/N: Wetlands Y/N: y� <br /> Lake/River Classification: Name of Water Body: p <br /> New Parcel Information <br /> C M J <br /> Proposed New Legal Description and Parcel Size: <br /> O <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> F <br /> Proposed access to public waters to be provided Y/N: m <br /> If yes,describe access: <br /> c Signature of Owner:, �`7 /C-�i�y Date: <br /> 00 Signature of Owner: t '(�1: Y� +p {�Q CIt-& Date: I Cl U `, 3 <br /> C <br /> ➢ Does parcel meet Zoning Requirements? Yes No i9 <br /> ac <br /> a ➢ Does parcel require a Survey? Ye- No ?q 0 <br /> Permit application fees submitted? ❑ Amount$ cg's-D, l] L) Receipt# 3 l J� <br /> ❑ Reconciles with Real Property Lister Yes No Date: O,) <br /> If not,explain: 0Wl <br /> N <br /> Application Approved Denied Reason for Denial O <br />