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Fees(must accompany torm): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or Gl!✓�J Pre-Application Form Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: MIll ymu- 4, y 1"/l LL Buyer: y <br /> Address: 36a / b 21Jd hvE N Address: 0 <br /> rM 63 <br /> Phone: 115- 16-56 156 3/3 / Phone: <br /> 0'7-632-a -q1-1j, z ss-5 Original Parcel Information 4//4/ <br /> D#: O ytld60 - `D7� Ran e /4 K/ <br /> Parcel <br /> ID#: <br /> el y ;/5[l�> - �d -dy7�(J Section � Township ,,,, Range /4 <br /> Original Description(or attach copy): E a 5 Z071- <br /> 1-6 <br /> of <br /> 6F Ble 3 182 At of M*&i ey <br /> Current Zoning: Floodplain Y,O Wetlands X <br /> Lake/River Classification: Name of Water Body: 44 <br /> Shoreland Agreemt or SIPS Y( Farmland Preservation V&_Managed Forestry Law Y(9-- <br /> New Parcel Inforrmattion <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: • (D� <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Y 1 ILLY 51-U P 1 d <br /> Proposed access to public waters to be provided Y/6- <br /> If <br /> / I:If ves, describe access: <br /> Signature of Owner: , 1 Date: <br /> Signature of Owner:VV)&J Date: g <br /> e <br /> ➢ Does parcel meet Zoning Requirements? yes No <br /> ?t <br /> 2 ➢ Does parcel require a Survey? yes No a <br /> 0 <br /> 0o T O <br /> D Permit application fees submitted? ❑ Amount$500-D V Receipt# w <br /> m ❑ Reconciles with Real Property Lister Yes No Date: t <br /> o ` <br /> a e <br /> If not,explain: <br /> e °o <br /> c V <br /> yr <br /> 0 <br /> Application• Approved / nied Reason for Denial: <br /> Land Use- — Date.• <br /> Q o <br />