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Fees(must accompany fonn): <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 or Map Review Form Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner Buyer: 3 <br /> �325o So A' 11' Rd <br /> Address: t \aM c Address: <br /> Gco.,,�s10y,ca . WZ s�-Ry-�o <br /> Phone: `S' �-� 3 - S7 0i 9 Phone: <br /> Orieinal Parcel Information u1pc,J lLe%— 00C <br /> G <br /> 0 <br /> ParcelID Section 1q Township38&Range <br /> O \ -000 - 0111 00 " <br /> Original Description(or attach copy): <br /> Tti E '/4 S '/4 -x�P tj� tie Oor- 6 ala Ft <br /> theca oF . <br /> U rl'2_00 e 8 Current Zoning: Floodplain Y(IN:�_Wetlands 1(/N: Lake/River Class: /l/4— <br /> ;e Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> o _ <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Informations ^�✓ �� Pl��!(� <br /> Proposed New Legal Description and Parcel Size: Lo-v 1 <br /> _S. ro <br /> 0fk!Sl" .A Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) b <br /> d.Pro (� 11 ''\ 11 m <br /> Proposed access to public road: NIA Rs 1 o t vM C S O. X11`\l o ns ?\A- <br /> Proposed <br /> posed access to public waters to be provided Y/N: T'i JA <br /> If yes, describe access: <br /> i <br /> XSignature of Owner: . Date: 10 - 267- /1 B <br /> A' Signature of Owner: M Date: A0 <br /> R <br /> ➢ Does parcel meet Zoning Requirements? /- Yes No Q J <br /> a ➢ Does parcel require a Survey? Yes No <br /> Permit application fees submitted? ❑ Amount$ .,�A5 t), Receipt# <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> r co <br /> If not,explain: <br /> 7y <br /> n <br /> ao <br /> y Applicati A enied Reason for Denial: <br /> OCT 24 2011 <br /> d <br /> Land Use: Date: _ (J <br /> 4 <br /> BURNETT COU <br /> ZONING <br /> a <br />