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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- $200.00+$50.00/lot <br /> Owner: RAA1+12ir In iot (0;ckntun Buyer: 9 <br /> A <br /> / 11 B <br /> Address:•1"/ff`� Kum 4c, 2 /Zd Address: <br /> t l_r ,5-ge30 <br /> Phone: QA5--&o6 ySlc3 Phone: _ <br /> Orieinal Parcel Information <br /> Parcel c,5-eVa- e'?L9e'0o Section t_ Townshi It' Range / <br /> Original Description(or attach copy): PCL L t!*'oy ki4 <br /> Current Zoning: RR IFloodplai 1% Wetland Y/ Lake/RiverClass: <br /> � 11 // <br /> Name of Water Body: fi o WL- <br /> � c k (L_ Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: /\ <br /> New Parcel r <br /> Information , •�� � <br /> Proposed New Legal Description and Parcel Size: /1J Pe ) �' 1 ti l 81 2 nM - 3 [ <br /> Acres: 0. z/r <br /> (if parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: � i STi A <br /> If yes,describe access: J <br /> u <br /> Signature of Owner: _.T" �•"K/�� Date: <br /> Signature of Owner:--at� o i Date: <br /> 9 <br /> c <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> Y Does parcel require a Survey? Yes No <br /> e <br /> 0° S' Permit application fees submitted? 7 4mount�f����_Receipt# <br /> r ❑ Reconciles with Real Property Lister/ Yea No Date:_ <br /> m <br /> 0 <br /> If not,explain: <br /> A <br /> Hie <br /> a <br /> Application: pprove Denied Reason for Deniai:_ -19_ <br /> I <br /> Land Use: �— �_ l? 7 zoo Date: ZONING_ J <br />