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Fees(mug accompany form): <br /> Burnett County Subdivision Permit Application Subdivision win Survey: 550.00 <br /> Survey of Existing Pareel: $50.001lol <br /> and/or Pre-Application Form SubdNisionw,Sarvev: s200.e0.s50.004a <br /> Owner: Qlki�✓i �nQ /lIL/1�i�lW Buyer: <br /> lv ,10/ I y9t* sal <br /> Address: Address: <br /> VIA/t, k <br /> Qy ,./— <br /> Phone: ) N <br /> 79q/ Phone: 5D7- 9.3S-7227 <br /> Y <br /> Q-0IZ"z-elQ-l�j- G aminal Parcel Information <br /> Parcel m p: O7-pIZ-Z'Y0-6;Jg P7 0-� Township YIAJ Range <br /> Original Description(or attach copy): Z47' 19 C'5m V5 P/9/ SCC 28) <br /> /Vw lvw Gov LoTI 4N�O Da.rr 0� <br /> F yyd' NE Nf 4y6 Al d{ KEF LN 5Ee aq <br /> Current Zoning: /s F lk— Floodplain Y/N: —' Wetland' is <br /> 1 <br /> Lake/River Classification: Name of Water Body: �— O <br /> New Parcel Information 1 <br /> Proposed New Legal Description and Parcel Size: <br /> r <br /> Acres: <br /> 1 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map,requirements.) <br /> Proposed access to public road: /y. PO/uUI- �KE lee aU <br /> o $ <br /> Proposed access to public waters to be provided 16:� <br /> 1 <br /> If yes,describe access: ,o i <br /> St Signature of Owner: l- Dater_ (d�1kl <br /> e <br /> e <br /> 00 Signature of Owner: Date: e <br /> a <br /> 9 <br /> D Does parcel meet Zoning Requirements? Yew No UK rU Su.r—+/- a ' <br /> I'lb'-13 J'1= <br /> ➢ Does parcel require a Survey? Yes No cra 1 <br /> C 9 <br /> R7 Permit application fees submitted? ❑ Amount S Receipt q I <br /> 0 <br /> 13 Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: 0 <br /> W <br /> Application: Denied Reason for Denial: <br /> h <br /> Land Use: . fl�fi Date: 3O�� <br />