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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 Subdivision w/Survev: 5200.00+$50.00/lot <br /> Owner: _1y'y' 1✓IAc-L:>cs Buyer: ro <br /> Address: 1910 _C21Q2G2EEr.J Address: a <br /> 0 <br /> Phone: SI Z S 07-1 Phone: <br /> Original Parcel Information p0., <br /> Parcel ID#: 0Q(n-Z0� Qj/0 Section /s Township 3U Range / <br /> O <br /> Original Description (or attach copy): LO-r- Z CSM Jr <br /> G6V, Z oT <br /> Sty Add�Pss 396t p `c . <br /> Current Zoning: 2 R Floodplain Y/N: �_ Wetlands Y/N: ��� { <br /> Lake/River Classification:�_Name of Water Body: M CIA 6Je� c_ A ILEF A <br /> o- <br /> Shoreland Aareemt or SIPS Y/N: Farmland Preservation Y/N: Manaeed Forestry Law Y/N: F <br /> New Parcel Information <br /> O <br /> Proposed New Legal Description and Parcel Size: <br /> sH of iViSeovl Iy1 Z" �'� <br /> `�1��.`�- w�I I ex c ,('� �� , ✓'e+,,..e�-t�� c�� f�2�f � 4 <br /> G J C:l_A SS 1 K Acres: �, A z - <br /> (If parcel is to be surveyed,provide�tp-r-eliminary map. See attached for preliminary map requirements..) <br /> Proposed access to public road: 'V ohs c,nl O c- 3'S- ^%f f�� ^ P 'S / C <br /> d <br /> Proposed access to public waters to be provided Y/N: <br /> If ves,describe access: V� <br /> /a-)/o 5 <br /> N Signature of Owner. � Date: 7 SJ <br /> 0 <br /> 0 <br /> w° Signature of Owner: Date: c <br /> a <br /> ➢ Does parcel meet Zoning Requirements? Yes No GYc 7z Jj-, <br /> a ➢ Does parcel require a Survey? Yes No <br /> o c <br /> C6 <br /> Permit application fees submitted? ❑ Amount$30O.O O Receipt# <br /> o t <br /> ° ❑ Reconciles with Real Property Lister Yes No Date: <br /> L. <br /> If not,explain: <br /> Q <br /> °p <br /> Applicat' Appr6ve9 Denied Reason for Denial: u- G <br /> Land Use: Date: / <br />