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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: 0.0 <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application FormSubdivision w/Survev: $200.00+$50.00/lot <br /> 1/ <br /> Owner: 1 W\ Ree—se- Buyero d <br /> Address: S�yL( p�Y,�� Address: 5 <br /> (,ueks-kr lcJl,s Sri?93 <br /> C, w <br /> Phone: 7i - H"7 Q L/ Phone: <br /> Orieinal Parcel Information <br /> Parcel ID#: 614/ - �J 0 a' b a.- OU o Section cr),_Township 3R Range 17 <br /> 1 <br /> O <br /> Original Description(or attach copy): L VY9 LVE y� S W D , 1 3q w <br /> 2 w fi <br /> b <br /> Current Zoning: _ R 3 Floodplain�/N`j Wetlands <br /> . <br /> Lake/River Classification: NA- Name of Water Body: f4 (r <br /> Shoreland Agreemt or SIPS YO—Farmland Preservation Y6)---Managed Forestry Law)6— <br /> New <br /> 6New Parcel Information <br /> Proposed New Legal Description and Parcel Size:/ - /F ya W Y kj ly SWYY <br /> y <br /> $GL rX ►Sc? N I ( w — (/Se-e A71 /y,/4 / IPAO o� <br /> Acres: 9iUy / JJ <br /> (If parcel is to be surveyed,provide <br /> ��preliminary <br /> )I map. See attached for preliminary map requirements.) <br /> Proposed access to public road: _l pF' rlUG�G �/YJnTC/rnC7 d <br /> Proposed access to public waters to be provided 1 p <br /> v'J <br /> If ves,describe access: <br /> _ 6 <br /> Signature of Owne - - Date: 'J O <br /> Signature of Owner: Date: B <br /> e <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> ➢ Does parcel require a Survey? Yes No 0 <br /> D Permit application fees submitted? ❑ Amount$ D L� Receipt# <br /> � w <br /> r o <br /> m ❑Reconciles with Real Property Lis�r Yes) No Date: 1 -U U $u <br /> e � <br /> a C <br /> �7 If not,explain: <br /> C6 �f n <br /> w <br /> r <br /> Application. Approv / Denied Reason for Denial: <br /> Land Use: Date ��_Q <br />