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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: $50.00Aot <br /> /� <br /> and/or Pre-Application Form Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: 4A ra-N (14Le% !7 fit; . Buyer: b <br /> m <br /> Address: 25'?•7 �/t C,.TmP 72 rj Address: <br /> z <br /> SI{E c:L LA ke k/ I S-45 <br /> 48.7/ <br /> Phone: 3 — Phone: <br /> Original Parcel Information <br /> 008 ' 2/33 0'7- ion <br /> Parcel ID#: Section '33 Township 3g Range �- O <br /> Original Description(or attach copy): U/ /fN/ 7 <br /> n A � <br /> Current Zoning: K ,`� Floodplain Y/N: ` O_L' Wetlands Y/N: �O `^ <br /> Lake/River Classification: Name of Water Body: Q� <br /> New Parcel Information (n <br /> Proposed New Legal Description and Parcel Size: 49P I- OF aAAD. AJ& C, S. 41. <br /> Acres: -4. 5-S,7- <br /> (If <br /> cres 4. SS7- <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Apse-d J T '/a 'TowN H*t.L, /7y,Rn <br /> d <br /> �O <br /> Proposed access to public waters to be provided Y/N: A <br /> If yes, describe access: <br /> SO <br /> oN Signature of Owner: Date: <br /> 0 <br /> vo <br /> Signature of Owner: _ Date: <br /> e <br /> ➢ Does parcel meet Zoning Requirements? Yes No n <br /> ➢ Does parcel require a Survey? Yes No 0� <br /> CL , <br /> � ➢ Permit application fees submitted? ❑ mount$ 25 0 'D U Receipt# �y <br /> n I <br /> 0 so <br /> o ❑ Reconciles with Real Property Lister Yes No Date: <br /> H / .. <br /> 03 <br /> If not,explain: <br /> 51J <br /> - O <br /> 0 <br /> Application• Approved Denied Reason for Denial: ( , <br /> Land Use: Date: / ` <br /> G <br />