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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: S50.00 <br /> Survey of Existing Parcel: S50.00/lot <br /> and/or Pre-Application Form or Map Review Form Subdivision w Survey: S200.00+S50.00/lot <br /> Owner: KA Y D. CNlWS EsrAI Sohri SaWws C;Vy{Ids et 3 <br /> 39,5 �� R� o? hn kti <br /> Address: Address: <br /> Phone: <br /> Phone: tpV <br /> CI <br /> Original Parcel Information <br /> Tax ID#: S.53T Section2L Township�x Range 15 W <br /> Original Description(or attach copy): 600. Lot ,� e4.42PE C$ VVL. 5 ltj .tit ,4IB4.U4 <br /> rst. <br /> loodplain Y/N: YPS Wetlands YIN: ys5 Lake/River Class: .3 <br /> Current Zoning: Rg <br /> Name of Water Body: (A/,id, Aro, 51.0415hf Shoreland Agreement/SIPS Y/N: AID <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: ValdrisktoM <br /> �, <br /> New Parcel Information Nn <br /> Proposed New Legal Description and Parcel Size: Seitieftivit CIF SSrArg - A4AP of SVQ(AV <br /> Ci: -the foi 41 2(0,so A0136, 'e~{I._ Easter* Per4iDA i "Portal 'K tVi ii c a a* <br /> ahead /b.55 Ateeb v Parcel 3 N La G0+i'41IM AA,*1423 Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) ..; <br /> Proposed access to public road: g3„seoso t from Barb Lake hid, <br /> 0 <br /> Proposed access to public waters to be provided Y/N: A /A <br /> Art'. 40.4( Con4eits uwaiaevider (, oiet$ g, s . <br /> Signature of Own . Date: 1 <br /> Signature of O er: Date: <br /> ao <br /> Fee Rec: /$b <br /> i Does parcel meet Zoning Requirements? Yes No Check#: l I&5 5 <br /> Does parcel require a Survey? Yes No -eve ►�� <br /> r.. <br /> x <br /> Reconciles with Real Property Lister Yes No Date: I <br /> r.. <br /> If not,explain: <br /> 0 <br /> z <br /> - z <br /> Application Approved Denied Reason for Denial. <br /> Land Use• Date: <br />