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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 Form Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: IJani d c'F � QrtzV I�t�ues��[ J <br /> J �Fc', $fifir- /PrPSct ct— /odd 'SarC�P_V� .e <br /> �rr II,' I' A <br /> Address: 5C''9 / — 1S4freT � (�Address: Il c/9 K) OCkc-5,'J.S C-1- B <br /> 4e_nA; YVIYI 5.53 N Arlo ke, II1,U S5"3e�`3 <br /> Phone: !So�' �.3.5 `/CSG' Phone: 62 1,9 _ aC�n— IKO' <br /> e7-ea9,7-�9-i8 at's Oridnal Parcel Information <br /> o.5-c�Y-ndsc� <br /> Parcel ID#: a -- cony-og0oeo c, <br /> ms-rnY-Oatcool0 Section a?1 Township 37 Range <br /> / / O <br /> Original Description(or attach copy): i e� j C.5 m V I P41 Tn &>-ftl 4n f `/ e <br /> _PC I- 6-p,, lets A/a-s e5m v1 P9/ _— } <br /> n Current Zoning: �.f\ oZ Floodplai> Y N: II'' Wetlands Lake/River Class: <br /> e Name of Water Body: f`) i 1 a,JC 4et 1`v e- Shoreland Agreement/SIPS Y/N r— <br /> .. Farmland Preservation YIN: Managed Forestry Law Y/N: <br /> New Parcel Information p p� <br /> Proposed New Legal Description and Parcel Size: �l/ec ) r c5 io' <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> yProposed access to public road: t� • C <br /> m <br /> A <br /> Proposed access to public waters to be provided Y/N: `p{t< <br /> If yes,describe access: <br /> Signature of Owner: Date: <br /> Signature of Owner: Date: o <br /> 3 <br /> r <br /> C <br /> Does parcel meet Zoning Requirements? Ye No A <br /> ➢ Does parcel require a Survey? Yes No <br /> o <br /> ao <br /> Permit application fees submitted? ❑ .4mount$_ Receipt# <br /> �. ❑ Reconciles with Real Property Lister Yes No Date: <br /> y <br /> 0 <br /> If not,explain: <br /> n <br /> CL0 <br /> C <br /> m <br /> Application: pproved / nied Reason for Denial: _ <br /> MAR - 4 2016 i <br /> Land Use• <br /> DA. _ <br /> BURNETT COUNTY <br /> ZONING <br />