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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 /> tI I and/or//Pre-Application Form L Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: W A S4V 1' (.Can/ 361 -7 <br /> � rru,S ` Buyer: W e J S� /� lezlS� ,o <br /> Address: 1?G' gG d / 36 1 / Address: / ,0' �/� l :?V 1 7 3 <br /> cp <br /> Phone: /I .S 6314 -1761 Phone: 6 Z 7 <br /> Ori final Parcel Information 0 <br /> logo <br /> Parcel ID#a7 ]( /( .2- 5 Q 1 -7 O :T GQOD aSection � Township 9 � Range <br /> W <br /> O <br /> Original Description (or attach copy): N W N W 3 �9l t -1 �✓ <br /> m <br /> (O <br /> Current Zoning: ro r25t Floodplain Y/N: l<' Wetlands Y/N: N Lake/River Class: tip <br /> a Name of Water Body: M kShoreland Agreement/SIPS Y/N: IV r <br /> g <br /> Farmland Preservation Y/N: N A Managed Forestry Law Y/N: N <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: N kE N v,) N�✓ 3' 3 Q r W PAA <br /> 3-L NW ua/ 3 39 N - )-7 W ;?0,,A F <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road:�A G� pQ �� X01$ bA20e4 t),- 6 k 4A4,L v <br /> Proposed access to public waters to be provided YIN: A/A <br /> If yes,describe access: <br /> Q � <br /> Signature of Owner: t�rf- Date: <br /> Signature of Owner: Date: c <br /> 3 <br /> 'O <br /> ➢ Does parcel meet Zoning Requirements? Yes No rK -10 "P " n <br /> ➢ Does parcel require a Survey? Yes No <br /> Q0 ➢ Permit application fees submitted? ❑ Amount$ Receipt# � <br /> sJ <br /> Reconciles with Real Property Lister Yes No Date: %:' f <br /> If not,explain: o <br /> � W <br /> a � <br /> y Applicatio . Approved / Denied Reason for Denial: <br /> _O <br /> Land Use: Date: <br /> 0 <br /> C <br />