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Fees(must accompany forth): <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: $200.00+$50.00/lot <br /> Owner: iaNtte 4. �InE ��S �Z (] Buyer: <br /> Address: (O } `1`� <br /> L -7 l' PE'c GAddress: <br /> —�nlU2�� <br /> (2O <br /> Phone: Phone: 9j <br /> oz-6 -QI9O - of <br /> Ori final Parcel Information Q� <br /> Parcel ID#: - 01 OC2 Section 2t Township Q Range <br /> O <br /> Original Description (or attach copy): Lc3TS 41 <br /> Ye6l> c �� ass �Sso1�(� PIm <br /> a <br /> m Current Zoning: 2 —( Floodplain Y/N: J\j _ Wetlands Y/N: <br /> Lake/River Classification: Name of Water Body: 1' _P d L"3 C_ <br /> Shoreland Agreemt or SIPS Y Farmland Preservation Y N: Manased Forestry Law Y/ (! S <br /> 0 <br /> New Parcel Information <br /> / 3 <br /> Proposed New Legal Description and Parcel Size: Z7e t J L I (( <br /> o �V'Q - d-,7-e da � <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: O <br /> 1 <br /> Proposed access to public waters to be provided Y/N: / rh <br /> 1I <br /> If ves,describe access: <br /> N Signature of Owner: Date: S- 7- D 8 <br /> 0 <br /> 0 <br /> o'o Signature of Owner: Date: 3 <br /> ➢ Does parcel meet Zoning Requirements? No <br /> m ➢ Does parcel require a Survey? Yes No <br /> 0 <br /> Permit application fees submitted? ❑ Amount S Receipt# o p <br /> o _ <br /> y ❑ Reconciles with Real Property Lister Yes No Date: a <br /> mac° O <br /> 0 <br /> If not,explain: <br /> O <br /> G <br /> Applicatio : Approved / enied Reason for Denial: <br /> Land Use: Date: j Y d <br />