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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 /> �1 rA <br /> � b <br /> Owner: M L '7 0�t� L� Buyer: <br /> Address: �f2 Address: o <br /> N <br /> Phone: Phone: <br /> Original Parcel Information g <br /> Tax ID#: ZZ Section 3 3 Township 33 >�ange /S <br /> O <br /> Original Description(or attach copy): <br /> �s <br /> v <br /> m <br /> RR- lood P . ,L1 _ 11� z <br /> v <br /> Current Zoning lain Y/N• Wetlands Y/N: Lake/River Class: a <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> o <br /> New Parcel Information { <br /> Proposed New Legal Description and Pa cel Size: 7 /d <br /> Acres: <br /> a <br /> b y <br /> X <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: W <br /> CS' <br /> If yes, describe access: <br /> Signature of Owner: Date: N <br /> Signature of Owner: Date: <br /> Fee Rec: /bs •�� <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> Check#: II ro <br /> ➢ Does parcel require a Survey? Yes No <br /> Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> Application. Approved / Denied Reason for <br /> /Denial- <br /> Land Use: Pm a Go d VVOe-d bV (::;N VLV Date: <br /> oA <br />