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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+$50.00/lot <br /> l)ton e'- <br /> Owner: <br /> 'Owner: I�.r� .,x knN,iro CFc,�.. Bu3mr: lA-)i(l:o T {caK,1Eo- 0,lzon ny <br /> I-eF I Luc z -moi <br /> Address: f 3 to Y /tet o IL:.r.rt. Q d n L,.lx, Address: s 9 7 z 1 z w . a <br /> z <br /> 0 <br /> SE, Ilwa.tc: � N &t tiSnR2 <br /> Phone: Phone: w <br /> Original Parcel Information U') <br /> L>/ I = 0325 2190 3&Q <br /> Parcel ID#: Section 19 Township 11 1 Range t I- <br /> O <br /> f <br /> Original Description (or attach copy): � <br /> LL f / = Doc. b 3t�Lf L1 FS <br /> 9 L lDf Z c U2.Z.ct 19414 L< i 7- k � 3C 31 lr� V33k <br /> .m' Current Zoning: a 0. Z Floodplain Y/N: _4_ Wetlands YIN: n <br /> f <br /> Lake 'ver Classification: C 1 c_ss z_ Name of Water Body: i�t,,,,, I_.•.K <br /> T <br /> Shoreland Aereemt or SIPS Y/N: Farmland Preservation Y/N: Manaeed Forestry Law Y/N: <br /> New Parcel Information 3 <br /> Proposed New Legal Description and Parcel Size: CsmV. a <br /> , a C <br /> C1 ,9 9 f?o.^sE. 1 . -6-7 L Cr" Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: z�r" <br /> G� <br /> Proposed access to public waters to be provided Y/N: <br /> If ves,describe access: <br /> c Signature of Owner: Date: <br /> e <br /> vo Signature of Owner: Date: n <br /> 0 <br /> a <br /> b <br /> ➢ Does parcel meet Zoning Requirements? Yes No ° <br /> m <br /> a ➢ Does parcel require a Survey? Yes No <br /> a ° W <br /> 70 ➢ Permit application fees submitted? ❑ Amount$ • (]U Receipt# Aj <br /> o Rel <br /> w ❑ Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: ° <br /> WW <br /> Od <br /> Application: Approved / Denied Reason for Denial: <br /> Land Use: Date: <br />