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Pees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision»-/o survey: $50.00 <br /> Survey of Existing Parcel: 550.00/lot <br /> and/or Pre-Application Form Subdivision W0 Survev: $200.00+$50.00/lot <br /> orHt.=2S <br /> Owner: fOgJ-J -9, SAuNDEIZS ¢ Buyer: <br /> A <br /> z <br /> Address: 5(000 CAVI hI C�rol-1 I-+J Address: <br /> -514oME WOOD Mtl 55331 ? <br /> 0 <br /> Phone: 9 .S Z 89 3 S Z(09 Phone: <br /> Original Parcel Information <br /> 07-0¢3 IDot 100 (� <br /> Parcel ID 4: 02o43 Iool Zoo Section Io Township 40 Ranged <br /> Original Description (or attach copy): VOL„ 5 F,o ATrRGNC-D o <br /> A <br /> z <br /> c� <br /> 7 <br /> 9 Current Zoning: Floodplain Y/N: rl Wetlands Y/N: N1 Lake/River Class: Z <br /> -o <br /> Name of Water Body: t-OV IS LXKf_" Shoreland Agreement/SIPS Y/N; /Jl/+- <br /> Farmland Preservation Y/N: /VIA- Managed Forestry Law Y/N: N1/} <br /> J <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: _...6%)2 LrT S $y CL 2rl F I oD <br /> SulzJr�( L=hCN Lc7' I's A, + }i <br /> 7-0 TA L. Acres: 7,3 y- <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) ��YY <br /> Proposed access to public road: g y PIZ IV A7-C- /ZCAD O <br /> / m <br /> Proposed access to public waters to be provided Y/N: ntIA- <br /> If yes,describe access: <br /> _ J <br /> Signature of Owner: Date: <br /> ,n S.., -Axr r t Nor J LK <br /> Signature of Owner: e`�j`'"h ' SIC Date: n <br /> 0 <br /> B <br /> c <br /> Does parcel meet Zoning Requirements? Yes No �(!G cS u. UCcv'ictic-cQ � <br /> u <br /> 'r Does parcel require a Survej,? Yes No tTF <br /> c 4j <br /> Permit application fees submitted? ❑ Amount S LIb L)' n b <br /> pp f _Receipt� <br /> - - W W <br /> d ❑ Reconciles with Real Property Lister Yes No Date:_____ <br /> AIf not,explain: <br /> c �j <br /> O <br /> Application: Approved / Denied Reason for Denial: <br /> Land Use: Date: <br />