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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: S200.00+$50.00/lot <br /> Owner: / G S D/1AKA luyer, <br /> Address: /'niao l • S <br /> /� )J // Address: A o <br /> Ci <br /> Phone: / / ' '79! �° 1 Phone: A <br /> � / C6 <br /> Orieinal Parcel Information <br /> Tax ID#: _7 A/� Section a I Township s.ZL Range 00 <br /> O <br /> Original Description(or attach copy):A) k) �( U ��j—e� a <br /> x � <br /> in <br /> a <br /> Current Zoning: Floodplain Y/N: nJ Wetlands Y/N: Lake/River Class: <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: �;' Managed Forestry Law Y/N: <br /> o a <br /> New Parcel Information <br /> Proposed New Legal Description d Parcel Size: a <br /> r 1k) EX f C r sjr V-1 Gj <br /> Acres: e <br /> lac h <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) X <br /> Proposed access to public road:e d Lc�S �(" i Q C./ 14 d �G <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> Signature of Owner: 1 Ad-^ <br /> CST f�.5 S EIt Tr /t zG j,C� J �'t'r y <br /> Signature of Owner: Date: <br /> ➢ Does parcel meet Zoning Requirements? Yes No Fee Rec:50'00 <br /> Check#:�(p _ <br /> ➢ Does parcel require a Survev? Yes No <br /> Reconciles with Real Property Lister Yes No Date: I(�2 2O2:Lf r <br /> If not,explain: ® <br /> U c D <br /> n <br /> Application: Approved Denied Reason for Denial• C C. <br /> o NJ <br /> Land U Date: <br /> C <br /> CD <br /> Sems. rtAA5-_ �Q Y DLIP_ ✓W�> r <br /> I <br />