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Fees(must accompany farm): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: S50,00 <br /> Survey of Existing Parcel: S50.00/jot <br /> and/or Pre-Application Form or Map Review Form Subdivision w/Survey: $200.00+$50.DM()t <br /> w env <br /> Owner: ND► Z-�?('Pf�P.lt GG� Buyer: 3 <br /> •V R <br /> -- � z <br /> Address:E L 7S- T7,17 X b4--l�r,1 3, kVD Address: ;? <br /> S'173k v� <br /> _ c <br /> Phone: �l� � a —3 l Phone: `^ <br /> �Q Original Parcel Information//� Cf <br /> Tax ID#; ZJ Sections Township Range =1 _ <br /> O <br /> Original Description(or attach copy) I vl e vL C t oy A <br /> ;t <br /> m <br /> r <br /> Current Zoning. Floodplain Y/Ni I` Wetlands Y/N: Lake/River Class;. <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation YIN: '—'�� Managed Forestry Law Y/N: a <br /> 0 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: ScP_ InAD6 <br /> R.4 CS M <br /> m <br /> c <br /> v <br /> ACreS' <br /> P preliminary P preliminary P requirements.) <br /> y <br /> (If parcel is to be surveyed, rovide relinttna map. attached for relinunar ma re uirements. <br /> Proposed access to public road: A �an <br /> Proposed access to public waters to be provided YIN: C7 <br /> If yes,describe access: <br /> SignatureafO*n- 11 J� Date: <br /> Signature-of Owner. N1 Date: <br /> ➢ Does parcel meet Zoning Requirements? Yes No Fee Rec 25� <br /> Ch1 eck#: 3591 <br /> ➢ Dotes parcel require a Survey? Yes No q K d A©6 �—qq <br /> Reconciles witb Real Property Lister Yes No Date: <br /> N not,explain: <br /> Applicatlo nnrovD;enied Reason for Denial! <br /> Land se. Ssf z"o � AP-Zs-os— Date: <br /> Z ZO Z� <br />