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Fees(must accompany toms): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: x50.00 <br /> and/or Pre-Application Form Surveysionof w/Survesting rcei: SSO.00flot <br /> /' TT �` PP �/ Subdivision w�survey: azoo.00+Sso.00not <br /> Owner: '?tvsw»m„ , GadRob"t2 (,4 Buyer: <br /> ro <br /> Address: _/Cb/ lj) /Sibs ti f Address: 9 <br /> Phone: Phone: j <br /> Orieinal Parcel Information <br /> Parcel ID#: ?-::2 1� 9r�Section J7 Township 31 Range�� <br /> O <br /> Original Description(or attach copy): .4/E 9 :01 <br /> v �l <br /> ^ <br /> Current Zoning: t 1 " o� Floodplain V9— Wetlands ''q <br /> A <br /> ?�) <br /> Lake/River Classification: 'Q 9r-A-%-d Name of Water Body: d <br /> Shoreland Agreemt or SIPS Ye Farmland Preservation Y�—Managed Forestry Law10— <br /> New <br /> N- _ <br /> New Parcel Information } <br /> ro <br /> Proposed New Legal Description and Parcel Size: �� Zq�ip�sk✓V iqy (i, <br /> __— Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) �\ <br /> // ✓ / r <br /> Proposed access to public road: _ /!G( /�./ �� 3Z9 ��N �• �� , d <br /> Proposed access to public waters to be provided <br /> If ves•describe access: <br /> Signature of Owner: Date: Z 2 e z � <br /> Signature of Owner: _ Date: o <br /> 9 <br /> ti <br /> ➢ Does parcel meet Zoning Requirements? Yes No ° <br /> eNti <br /> e. ➢ Does parcel require a Survey? yes No 'k <br /> Permit application fees submitted? ❑ Amount$i 6 � o U Receipt# 6 j5 / y <br /> e ❑ Reconciles with Real Property Lister No Date: <br /> a �A1 <br /> VIf not,explain: (U <br /> o J•+ <br /> CL i <br /> N <br /> Application Approved / enied Reason for Denial: <br /> O <br /> C, <br /> Land Use Date: �y-0� <br />