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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: $50.00/lot <br /> and/or Pre-Application <br /> ( Form Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: L) -56e, f[ To f l h 50 1 Buyer: o f "f"V�e Y G/�I2 h 9 <br /> //� <br /> A <br /> Address: ]) L ake S,d.*- l.(t; Address: 3 <br /> Phone: Phone: <br /> Original Parcel Information <br /> Parcel ID#: Section Townshie Range <br /> O <br /> s <br /> Original Description(or attach copy): '7 Cd i .JL.e'U.cd <br /> 5'+Jtr NESE SGS. 3a -/7V-3 2I.�—NL/ T v. ja <br /> � yhhe- la/ <br /> Current Zoning: Floodplain Y/N: Wetlands Y/N:� Lake/River Class: w �� <br /> X., Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: C)A <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: ^ <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: p <br /> Dt <br /> Proposed access to public waters to be provided YIN: <br /> If yes,describe access: <br /> Signature of Owner: Date: <br /> Signature of Owner: Date: o <br /> c <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> ➢ Does parcel require a Survey? Yes <br /> o' <br /> 00 ➢ Permit application fees submitted? Amount$ Receipt# <br /> r ❑ Reconciles with Real Property ListeYes No Date: <br /> m <br /> 0 <br /> If not,explain: <br /> A <br /> MON <br /> A <br /> n <br /> 0 <br /> a <br /> Applicatio . Appro�ed enied Reason for Denial: <br /> �✓vor rrt LO C�7 9 ziQGT 13 2916 <br /> Land Us �Ile 2©/ Date: <br /> BURNETT COUNTY <br /> ZONING <br />