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Fee' <br /> (must accompany corm): <br /> Burnett County Subdivision Permit Application SOdlvisionw/.Survey: aso.00 <br /> Survey of Existing Nrccl: E50.00/lat <br /> and/or Pre-Application Form Subdisisi�on w/Survey: 1200.00*550.001ot <br /> Owner: 1'1rw W 7iA�DJo I Buyer: n <br /> Address: V,6_4 2 Z Ir (/ N a (rce^ rJ Address: � 1/Y' 'A /! � j ^c 3 <br /> � z <br /> Cu <br /> Phone: C 35 33 ,057 Phone: - 7/S 2/C7 �2 4 <br /> Orieinal Parcel Information (� <br /> (,/IGYXI V-r <br /> Parcel ID#: (:7_ols+_2'�-/U-2Z-9 at/_GOD- y¢ctian `'�'7-- Township >>C/ Range <br /> O <br /> Original Description(or attach copy): <br /> i <br /> D <br /> 9 <br /> 9 n_ <br /> n Current Zoning _ Floodplai Y Welland Y, : —� <br /> 0 <br /> LakelRiver Classification: �_ Name of Water Body: F-- <br /> r <br /> Shorcland Agreemt or SIPS Farmland Preservation Y M112naged Forestry Law Y6: J <br /> �1 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: �)c <br /> Acres: iZb- ZN �j <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: �nt+ t o K Q4P[__ o <br /> Proposed access to public waters to be provided': 0 C <br /> If ves,describe access: --�—� <br /> Signature of Ownen,y-, Date: <br /> Signature of Owner: Date: 3 i <br /> a <br /> e <br /> D Does parcel meet Zoning Requirements? Yes No <br /> N <br /> a <br /> ➢ Does parcel require a Survey? Yes No <br /> � O <br /> ri Permit app(icationjees submitted? AnmuntS5�, QD Receipt# -c,- <br /> Reconciles <br /> SReconciles with Real Property Lister / \•Yes No Date: —'57/n /2n/7-) <br /> 6 <br /> A If not,ezplain: o <br /> a <br /> ApplicatioiC <br /> Approved / enied Reason for Denial: <br /> Land Use: Date: . <br />