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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 /> n and/or Pre-Application Form / 1 Subdivision <br /> ww/Survev: $20 "'000/1 <br /> Owner: . . i d-�ar0 I Le[! GI F''ENBuycr: q , <br /> Address: ��C�SS Address: �I l a a��1� J I ve ' <br /> z <br /> I � �P r (J� �18�i3 �'I't%n n,eapo/(s <br /> / W <br /> Phone: 6 Phone: <br /> J <br /> Original Parcel Information <br /> Parcel ID#: Q OS l oy Section 2-6Township Sli_L_Range t/ <br /> ' ��/ N <br /> Original Description(or attach copy): /�/ E I& <br /> O <br /> AJ <br /> a � <br /> `` ,, <br /> e Current Zoning: 1�1� 3 Floodplain YIN: !v ,/Wetlands/Y/N (4� <br /> ~ Lake/River Classification. 3 Name of Water Body: , /— <br /> Shoreland Agreemt or SIPS Y/N:�Farmland Preservation YIN: Managed Forestry Law Y/N: /V <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: I ` �2 a T� <br /> S� IIzb � TA) ., Yz ) LLJ <br /> Acres: a-0 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: N 60.55 " <br /> Proposed access to public waters to be provided Y/N: �— <br /> If ves,describe access: <br /> Date: <br /> Signature of Owner: <br /> Date, <br /> Signature of Owner: 3 <br /> c <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> ➢ Does parcel require a Survey? Yes No p <br /> o pC <br /> Receipt# <br /> Permit application fees submitted? Amount$. p <br /> m ❑ Reconciles with Real Property Lis Yes No Date: A) <br /> L _ <br /> 7e If not,explain: <br /> ra <br /> o '1' <br /> ti <br /> a <br /> N <br /> c <br /> Application Approved / eniedReason for Denial: y/ <br /> Date: f�a�"�� <br /> Land Use:77 <br />