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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: ` y1 .Clzi IA LJlG B� � 1A <br /> Address: W4S66 PjIGNCL-L LUNE Address: 3 <br /> wr s�479 <br /> Phone: �s d Phone: <br /> Orieinal Parcel Information .Jo <br /> Parcel EDM O!9-j3?y-tXY�Ot O J�� Section —2 Township / Range <br /> Original Description (or attach copy): <br /> n <br /> y s' <br /> m Current Zoning: Floodplain YIN: Wetlands YIN: Y <br /> e W <br /> Lake/River Classification: r , Name of Water Body: ' <br /> Shoreland Aereemt or SIPS Y/N: / � Farmland Preservation Y/N: Manaeed Forestry Law Y/N: /I y <br /> New Parcel Information a <br /> Proposed New Legal Description and Parcel Size: "I- <br /> CS(Vj <br /> I-CSM ©f EK,e-- <br /> Acres: <br /> (If parcel is to be surveyed,providepreliminarymap. See attached <br /> for preliminary map requirements.) <br /> Proposed access to public road: (�I �e C 1 <<P ss J C5 70 l E S Y10 �I d <br /> Proposed access to public waters to be provided YIN: _ ✓ <br /> If ves,describe access: <br /> N Signature of Owner: N/A tJ of Sabo/ t S t o Date: d <br /> 0 <br /> o°o Signature of Owner: Date: 3 <br /> ➢ Does parcel meet Zoning Requirements? Yes No F <br /> se <br /> m ➢ Does parcel require a Survey? Yes No <br /> a <br /> Permit application fees submitted? ❑ Amount S 00 Receipt# C <br /> o <br /> n ❑ Reconciles with Real Property Lister Yes No Date: <br /> N <br /> If not,explain: <br /> O <br /> 1 <br /> O <br /> Application: pproved / Med Reason for Denial: c <br /> Land Use: Date: 4O`�� —� <br />