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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> Subdioldh <br /> ve <br /> and/or Pre-Application Form /I subd�krS 1wvl�`F&�t v. E <br /> Owner: i-f io 19UP7/6 O�yvag ye+� 1. F <br /> Address: Z 76 ZS 6,4,6Z&j XO Address: NgZZ7 /6l5nL 6 <br /> we SS t-6- *135489 /�i U lit. .QIlS� 7N; 5yoa - o <br /> 966-killPhone: Phone: <br /> L/ 33 3-0/ /00 Original Parcel Information QZ 0- 33 L 02_X0 <br /> Pa reel ID#: Section Township 4o Range 16 <br /> Original Description (or attach copy): 6.4 <br /> A <br /> -t <br /> f� <br /> O <br /> a Current Zoning: I Floodplain Y/6 Wetlands YQ [\ <br /> S <br /> Lake/River Classification: - Name of Water Body: 4 <br /> Shoreland Agreemt or SIPS ' - Farmland Preservation Y/0_Managed Forestry Law Y/tV_ <br /> 5 <br /> New Parcel Information 5 <br /> Proposed New Legal Description and Parcel Size: N U�JeIL/p�7dti/.S — <br /> Acres. <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> m <br /> Proposed access to public waters to be provided YO A <br /> If Yes,describe access: <br /> c Signature of Owner: w Dater <br /> Q <br /> a'o Signature of Owner: ] 'p Date: 110141A, 9 <br /> ➢ Does parcel meet Zoning Requirements? - Yes No Oi- pPIU-�4-t� <br /> ➢ Does parcel require a Survey? Yes. No p <br /> a �n p <br /> Z ➢ PerMit application fees submitted? 11 Amount$ / <br /> _ w D ' 00, <br /> Receipt# o <br /> ❑ WReconciles with Real Property Lister Yes No Date; � <br /> W <br /> If not,explain: a <br /> W <br /> 0 <br /> U G <br /> P � <br /> Application• A n•ov enied ReasonforDenial: <br /> Land Use: Date:l��`o'y��� <br />