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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 Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner:K a rk N lDI e;rt Ga `al l 1 tBuyergo: <br /> Address:', ( O I Yt41I Sp000e v IN [ Stfi 0( Address: GA <br /> ro o <br /> GI CI: <br /> Phone: 1 -1- o - 4 _`(0 Phone: <br /> 1 . <br /> Original Parcel Information <br /> Tax ID#: I 1.0 2-1 L' Section 3 Township 3. Range 14 <br /> Original Description(or attach copy): 6 E- 5k.,.� O <br /> 0 <br /> eD <br /> rs <br /> 10 <br /> ,. <br /> Current Zoning: R 9—.. Floodplain Y/N: Wetlands YIN: 11 Lake/River Class: i ` <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation YIN: Managed Forestry Law Y/N: <br /> New Parcel Information • <br /> Proposed New Legal Description and Parcel Size: a.Cr-(- - D 0zit,<--\ L., + Z <br /> 3S a c•-e— 0-4,..r. ,-.. 4- L u i- I t <br /> t <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: y <br /> k <br /> Proposed access to public waters to be provided Y/N: E <br /> If yes,describe acce : <br /> 8 3 a�::: <br /> of Owner: Date: 'of Ow Date: <br /> Fee Rec:500, <br /> > Does parcel ntee oni g Requirements. Yes No Check#: Lf 93q <br /> Does parcel require a Survey? Yes Norr <br /> r <br /> D <br /> z <br /> a <br /> U <br /> ts7 <br /> Reconciles with Real Property Lister Yes No Date: Fi <br /> V! <br /> y <br /> If not,explain: <br /> c <br /> z <br /> r <br /> Applicatio,. Approved / D• 'ed Reason for Denial. rn <br /> 1,1 <br /> Land Use: Date: <br /> 2-,,4-e.-e..-- --4-2------------ <br /> Ø / a ' cn <br />