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Fees(must aceompam form). <br /> Burnett County Subdivision Permit Application Subdrvisim,w/oSurvey S5000 <br /> Survey of Existing Parcel. $50.00/lot <br /> and/or Pre-Application Form Subdivision A/Survey $20000+$5000nat <br /> Owner: (' L C-l L i R OLi✓r Buyer: /V .o <br /> z <br /> Address: R 0 , 6 eY / 7-Z5 Address: <br /> S12CIJ <br /> W <br /> Phone: 7 i 5 - -791 - 9 3 8 1 Phone: Ll <br /> Original Parcel Information 01 <br /> Parcel ID#: O o(y Z 41/ O 1 Cp 1 o Section 1 (_Township 3 S Range <br /> O <br /> Original Description(or attach copy): N 1593 ' or Y✓ 4-9-o' dF N1,/'/¢- Nb✓I,'+- <br /> > <br /> ' - <br /> o Current Zoning: A Z- Floodplain YIN: /✓ Wetlands YIN: /✓ Lake/River Class: /✓A- <br /> m Name of Water Body: N14 Shoreland Agreement/SIPS Y/N: <br /> e <br /> .. Farmland Preservation Y/N: f%1 Managed Forestry Law Y/N: A/ <br /> New Parcel Information e'5m V,a4 Pe" L{5-01L,k,o <br /> Proposed New Legal Description and Parcel Size: C2CRTE /} dNE Lot' CSM <br /> of ff x Is rt td G r'W2CC- C <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: off✓ SD✓FnIJOrJ R"P Yfw^I rsffe/z,6 go O <br /> Proposed access to public waters to be provided Y/N: n/ <br /> P <br /> If yes,describe access: 9-) <br /> v <br /> / v <br /> Signature of Owner: l(1 e r.('ia y- � "i�L�C Date: <br /> Signature of Owner: Date: o <br /> 3 <br /> 9 <br /> ➢ Does parcel meet Zoning Requirements? Y'es No U h <br /> � � 9-18•ta- <br /> Does parcel require a Surrey? Yes -- TU jA96 tt t <br /> O SOg7 <br /> 00 ➢ <br /> Permit aplicationreessubmitted? / \ Amount% ��oM Receipt r __ RJ <br /> SU <br /> t <br /> r ❑ Reconciles with Real Property Lister Yes No Date: <br /> w <br /> ° If not,explain: <br /> 0 <br /> a Q <br /> w <br /> Application: Approved Denied Reason for Denial: n <br /> Land Use: Date: <br />