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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: $50.00Aot <br /> � ,�-�, and/or Pre-Application Form Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner:l.1/i—Ldp 5; • V�iCY 5 Buyer: C--1 u 3w.<-r SA`c� wOyme A. <br /> Address: 'Y�l Jl ) \ 1 Ce Address: \l G,Aq �PK1 Q �l A fhl4? . A� 0 <br /> 55-] DE1 CoL�� Ssto Q <br /> Phone. , .. Phone: <br /> Oriaina►Parcel Information SC6-rt' <br /> ParcelID ection02 Township44U1J RangeILI W O <br /> �. ptOriginal Description or attach copy)-.`JOUAA &L& k A.�K1�aS-lt- <br /> � <br /> 0< r <br /> Current ZoningL.9%I Floodplain YIN: Q—Wetlands YIN: N Lake/River Class: <br /> g <br /> eName of Water Body: ` Shoreland Agreement/SIPS Y''/11N,, <br /> ~ Farmland Preservation Y/N: Managed Forestry Law Y/N: N <br /> New Parcel Information ((�� <br /> Proposed New Legal Description and Parcel Size:FR`'i� Int° yxkK"r n-� AT'll <br /> t" •fir Q t1�Af artrr (}�c `C�S�r ^�'�Z f Sec�n an <br /> Acres: c�n <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: N <br /> i <br /> If yes,describe access: <br /> 1 <br /> , � <br /> Signature of Owner: Date: l �' <br /> n <br /> Signature of Owner: Date: 9 <br /> 'O <br /> w <br /> Does parcel meet Zoning Requirements? Yes No Q TAP <br /> c ➢ Does parcel require a Survey? Yes No ) <br /> w <br /> ➢ Permit application fees submitted? ¢i, Amount$ �o � Receipt 90� <br /> r., econciles with Real Property Lister / Yes No Date: <br /> m <br /> o a <br /> a If not,explain: Al <br /> o <br /> ApplicatiApproved / enied Reason for Denial: <br /> Date: BURNETT COUNTY <br /> Land use: ZONING <br />