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Fees(must accompany form): <br /> Burnett County Subdivision Permit/Survey Review Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.00flot <br /> Application and/or Pre-Application Form Subdivision w/Survev: $20000.0000+$50.00/lot <br /> / <br /> Owner:( sy aL'f I e S 4y1 e- Buyer: ko he 3 • 4,�e J 1( • .d <br /> n <br /> Address: a.3 la 7 0/4 3�) Address: 5-/0/ - o� 8 � qye <br /> StteKt JV872- �1 nn of%5� �/i SS�/7 P <br /> Phone: fo ( a - oZe2 L - / a D Phone: /1 - 7oZ 9- �DoZ l C <br /> O� as Original Parcel Information <br /> a- a 38- 1-15 5 o$_ 01 -ollwo <br /> Parcel ID#: 00(0 y 3-IOU Section15 Township 3 Range <br /> /� <br /> O <br /> Original Description(or attach copy): 0, . �-- <br /> m <br /> Q <br /> I � <br /> Current Zoning: t�, Floodplai Y Wetland Lake/River Class: <br /> Name of Water Body: tgCl Shoreland AgreementlSIPS Yee <br /> F, Farmland Preservation Y)6Managed Forestry Law Y&2- <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: hS t r nt <br /> Acres::r01t tl Q � <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: S-rS, d <br /> Proposed access to public waters to be provide�Y/ L'Fl��'U (� ., T PAP-ce- <br /> If yes,describe access: ae p <br /> Signature of Owner: Date: 41."2­ <br /> Signature of Owner: Date: I <br /> ➢ Does parcel meet Zoning Requirements? Yes` No <br /> ➢ Does parcel require a Survev? Yes No ! S <br /> 00 ➢ Permit application fees submitted? ❑ Amount$ 9 5 0"0 Q Receipt# <br /> 9J <br /> r., ❑ Reconciles with Real Property Lister Yes No Date: W <br /> o U° <br /> If not,explain: J <br /> e (/ <br /> Application: proved enied Reason for Denial: g <br /> 0 <br /> Land Use: Date: (v ��3 Z 0 <br />