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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: $50.0011ot <br /> and/or Pre-Application Form Subdivision w/Survev: $200.00+$50.00IIot <br /> Owner: (6 A/17J/Du141-r-��/ Buyer: b <br /> Address: T- Bd X 11 b Address: 3 <br /> Phone: T �� <br /> Phone: �} <br /> Ori¢inal Parcel Information <br /> tJ3d— l530gq_02700 Section 27 Township g qq <br /> Parcel n)#: �N Ran e �b <br /> 11 / /� O <br /> Original Description (or attach copy): Per Id N 6W L� ( S OT <br /> y'bl 1ki Veli, EX cin V � P ;266 L <br /> .2X hwu u dpfac. * 3,7 <br /> R3Current Zoning: l� 3 Floodplain Y6 Wetlands YQ <br /> Lake/River Classification: Name of Water Body: C1 <br /> Shoreland Agreemt or SIPS YftFarmland Preservation Y,Oi _Managed Forestry Law Y6_ <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: .3 4•ll (:SA <br /> Acres: f h; Acke. <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: yf-t C <br /> m <br /> Proposed access to public waters to be provided Yd) g <br /> J <br /> If yes,describe access: <br /> o Signature of Owner: �• Date: "s �O CA <br /> e <br /> e <br /> 0° Signature of Owner: Date: 3 <br /> e <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> ➢ Does parcel require a Survey? No it <br /> a C7 <br /> D Permit application fees submitted? ❑ Amount$ 35 D d b Receipt# b <br /> c <br /> a <br /> ^ ❑ Reconciles with Real Property Lister Yes No Date: <br /> W <br /> If not,explain: 93 <br /> J <br /> 0 <br /> 9� <br /> J <br /> Application: Approve / Denied Reason for Denial: C <br /> Land Use: Date: <br />