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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 /> and/or Pre-Application Form Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner. W '12,d �1j��,1//S!�/r�f' Buyer: <br /> Address: 1/�LSKL�� s49:J� Address: B <br /> Phone: 7l _ �� r l l� Phone: <br /> Original Parcel Information Y) <br /> (Yl <br /> Parcel ID#: 03 2 s 22 2.0 t 9 00 t Section ZZ Township 4—I Ranged <br /> O <br /> Original Description(or attach copy): A1TAC) C-0 `o <br /> A <br /> o Current Zoning: RRZ. Floodplain Y/N: SOMI.: Wetlands Y/N: tJ Lake/River Class: <br /> 9 <br /> Name of Water Body: Z(P LArKF— Shoreland Agreement/SIPS Y/N-, tj <br /> O <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: n) <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: C omt5l a IF— 7V40 FAIZC.Et.S <br /> pV G S m To- G2C-Ar 00C LOT-, <br /> Acres: Abour <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Z•(p Lk KE X-0 O <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: p ti 2 /0 1.P.K6 <br /> Signature of Owner: ) ^ X Date: ell' jy- <br /> Signature of Owner: Date: 3 <br /> C <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> °oN ➢ Does parcel require a Survey? Yes No <br /> ➢ Permit application fees submitted? Amount$ Receipt# p <br /> 0 Reconciles with Real Property Lister Yes No Date: C, <br /> If not,explain: <br /> A k) <br /> o I i <br /> o v <br /> I <br /> Applicatio pproved enied Reason for Denial: LA <br /> Land Use: Date: <br />