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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdiv sion w/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.00/1ol <br /> CI,, and/or Pre-Application Form Subdivision w/Survev: $200.00+$50.00/lot <br /> ^ Owner: 15heI1GI. f�l(I(ao2s Buyer: ^o <br /> Address: 4D 3q a )s+A-L)e S, Address: s <br /> 0� rvlr-LeaPall's <br /> —r— w <br /> Phone: Phone: <br /> OriOnal Parcel Information <br /> 017-034 a 3.7-Ig- aq-S-GS-00A-01�I00 /O <br /> Parcel ID#: Sectiones Township 1 Range O <br /> O <br /> Original Description(or attach copy): PCI 6OV Lot a �� /J 6 <br /> Pest -ir 393°1 (,3 Ex tf <br /> �7� i <br /> , o <br /> �urre:.t Zoning: !VG-a i•:uY. i 'et:�idr:»ia <br /> .:: ande Y/N: <br /> Lake/River Classification: I Name of Water Body: <br /> Shoreland Agreemt or SIPS Y/N: Farmland Preservation Y/N:_Managed Forestry Law Y/N:_ A. <br /> New Parcel Information c <br /> Proposed New LegalDescriptionand Parcel Size: Lot 2- O 1 0 ( Ce( 1} <br /> l FiQ <br /> ed t � lo.P Wtk� lOC Le Pass z�\ �or _�h� <br /> -V�oL,\n Aa.fete S Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: N/ 4 d <br /> m <br /> Proposed access to public waters to be provided Y/N: <br /> If ves,describe access: W <br /> Stere a[t)�vaer.t 1� �i 1.V lL <br /> s <br /> .0 .. n Date: � <br /> Sienature of Owner: Date: n <br /> e <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> ➢ Does parcel require a Survey? No o <br /> /` Io J <br /> Permit application fees submitted? ❑ Amount s �, 0D Receipt# I A) V <br /> W <br /> d ❑ Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: j <br /> 0 <br /> m � <br /> Applicatio Approved enied Reason for Denial: Kc, V L/ <br /> d <br /> Land Use: Date: <br />