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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: 5200.00+$50.00/lot <br /> l)con V'- <br /> Owner: <br /> ;Owner: rh_A 9 k n N C}c'.1., � Ryer: le i l l; t<cdt 1 <br /> i-CF I Lur z fDi <br /> Address: is(,tr Noku: .ck Qd t„ n7vn, Address: g 9 7 z, Utz sfi, w . 8 <br /> z <br /> 0 <br /> S♦, Ilw,.t c.� � Mei tiSnfiL t,-c,tceU;l.,p M .J S5�4y <br /> Phone: Phone: <br /> Original Parcel Information <br /> Lair I = 0325 �/4p 34 o u <br /> Parcel ID#: L,,)12= o s z s z t v e 3 5 ro Section 1 9 Township f j Range i.�- <br /> O <br /> Original Description (or attach copy): o <br /> m <br /> Lt f l C_ b tt Ll ftS <br /> a �• <br /> 9 L31Z c l/ 2.U-t j9441c lZC'l•t G. 3C 51 li,k �, t ll 33k rlkt r r. a <br /> Current Zoning: Q 0. 2 Floodplain YIN: Wetlands Y/N: .4 A <br /> r <br /> Lake 'ver Classification: C 1 c_z5 Z Name of Water Body: i c t,„� 1_e.K <br /> S <br /> Shoreland Aereemt or SIPS Y/N: Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> Csm V a� P I;a-B <br /> c fCS Al S 7� <br /> 0 .99 acre I -b7 0.c Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: bra d s 2. d <br /> Proposed access to public waters to be provided YIN: <br /> If ves,describe access: v V'5 <br /> c Signature of Owner: Date: <br /> 0 <br /> Signature of Owner: Date: e <br /> a <br /> Does parcel meet Zoning Requirements? Yes No <br /> m ➢ Does parcel require a Survey? Yes No <br /> a <br /> ° W <br /> M ➢ Permit application fees submitted? ❑ Amount$ U w Receipt# s <br /> W <br /> y 11Reconciles with Real Property Lister Yes No Date: zs x, <br /> If not,explain: ° <br /> ww <br /> ° <br /> � d <br /> Application: Approved / Denied Reason for Denial: <br /> Land Use: Date: <br />