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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision wo Survey: $50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application Form or Map Review Form Subdivision w/Survey: S200.00+S50.00/lot <br /> Owner: One i S • Tt�et Zu. Iryes+' Buyer: f= <br /> Address: f I L111 Q.•efs.,y Ave- 0. Address: ? o <br /> 1-m).-v•,p1;... , MIJ 55 31141 N <br /> Phone: Phone: <br /> iV <br /> O. <br /> Original Parcel Information <br /> Tax ID#: 15a 37 Section I1 Township Range 1Li O <br /> Original Description(or attach copy): <br /> 754 N. <br /> l <br /> N <br /> I <br /> i N' <br /> 0 <br /> Current Zoning: Y Floodplain Y/N: Y Wetlands YIN: Y Lake/River Class: a <br /> Name of Water Body: Zot_ty �:�� t �isie Shoreland Agreement/SIPS Y/N: 40 <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: Ai f_ <br /> New Parcel Information ,fd <br /> Proposed New Legal Description and Parcel Size: 1--r-YV f -5\•CN = ACrGS I L>k 2 13.2i Ac- <br /> 1 <br /> a <br /> 4 <br /> Acres- <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: rent clo-,,.q t7 <br /> Proposed access to public waters to be provided Y/N: ►3..) <br /> If yes, describe access: {�J,�� 1 W <br /> Signature of Owner: "1 i-`9- e4/ �!`*rfaz- �7 t- Date: 75 9 -t9Dc7'y <br /> Signature of Owner: Date: ,y <br /> Fee Rec1f>o300 <br /> Does parcel meet Zoning Requirements? Yes No <br /> Check#:/a/5 <br /> i Does parcel require a Survey? Yes No <br /> Reconciles with Real Property Lister Yes No Date: J <br /> a) <br /> w MIIf not,explain: n p <br /> cn co CI 0 <br /> m inn] <br /> Approved / D nied Reason for Denial- <br /> ___ p o ^, o <br /> Land U- • Date: S N <br />