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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parce $50.0 <br /> and/or Pre-Application Form Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: .7C-0JZ #'r NA (5L (.— Buyer: <br /> n, <br /> � <br /> Address: 24Z.1Z WµtSP��'2.+rJG F1Ntsj (+ddpress: - <br /> AAN13u2� <br /> s�1-S3o � <br /> Phone: co 12- 6 (9 19191 Phone: <br /> Orieinal Parcel Information OO <br /> a I z4za )o7zob <br /> Parcel IDN: b 1 Z.4 Z.o I o-7 3o0 Section l Z Township ¢o Range 1 <br /> O <br /> Original Description(or attach copy): L o T 1 o0T LCT- CSM VOL , (io , <br /> PA6CS 32-9 -" 330 <br /> .a Curren[Zoning: Floodplain Y/N: Wetlands Y/N: Lake/River Class: Z <br /> eName of Water Body: L Oo n/ L lk K4—:7 Shoreland Agreement/SIPS Y/N: 11i <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: IJ A <br /> New Parcel Information <br /> 5a <br /> Proposed New Legal Description and Parcel Size: Golvt P'1 N +r/1 II O L I LS)7b 1=02M 00 C- NL W Lo-r BY CSM V aim 4j • Ng-IStD <br /> Acres: 113 t <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: p l(Lae-T- &CC Ef S TZ) W I+IS PL`2 10 6 FIN 1$S IZ.D <br /> Proposed access to public waters to be provided Y/N: N fE <br /> If yes,describe access: <br /> S_ <br /> i <br /> Signature of Owner: Date: <br /> Signature of Owner: Date: o <br /> B <br /> ➢ Does parcel meet Zoning Requirements? Yes No r 2 �pp <br /> ' z <br /> u <br /> 6 ➢ Does parcel require a Survey? Yes No a- <br /> as _ <br /> Permit application fees submitted? ❑ Amount$ J ' Recetpt91 <br /> v y, <br /> r <br /> ❑ Reconciles with Real Property Lister Yes No Date: _ <br /> e <br /> If not,explain: �1 _ <br /> $ � o <br /> ,C 41 <br /> o L <br /> � 6 <br /> Applicatio rov Denied Reason for Denial: a. r <br /> CO PPp <br /> Date: <br /> Land Use: <br /> t o <br /> O b <br /> a p <br /> 00 <br />