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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 /> ��/� <br /> and/or Pre-Application Form Subdivision w/Survev: $200.00+550.00/lot <br /> Owner: 6ICJ/t.'G �Jp(J/ f�(}J1/ Buyer: ti <br /> Address: 317d3 Afd� i'D> L3 <br /> Address• <br /> ALJ `/tel <br /> Phone: // 5- k J(O- / 9?091 Phone: <br /> Original Parcel Information <br /> — 2 0/ 000 0 <br /> Parcel ID#:07-03oL'2-y//S'/85- $-bb/-D//00oSection� Township_ Range <br /> D �,• -' O <br /> Original Description(or attach copy): _NE A w (� /}��,Q�yf��(/C�� 6 � <br /> �� � � z <br /> y <br /> Current Zoning: t Floodplain Y VWetlands Y49 D <br /> 0 <br /> Lake/River Classification: Name of Water Body: <br /> Shoreland Agreemt or SIPS Y N�j�. Farmland Preservation Yl (�:_Managed Forestry Law yo___ Z <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: /1 k o ~ 'C S <br /> 3� <br /> Acres: <br /> _. <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C <br /> m <br /> Proposed access to public waters to be provided Y <br /> If ves,describe access: <br /> o Signature of OwneaolLDate: <br /> Signature of Owner: / Date: e <br /> 9 <br /> e <br /> D Does parcel meet Zoning Requirements? Yes No g <br /> ➢ Does parcel require a Survey? Y No <br /> C6 r W <br /> Permit application fees submitted? ❑ Amount$ 400 O 0 Receipt# b 5 5 J <br /> e <br /> y ❑ Reconciles with Real Property Lister Yes No Date: U <br /> .. . . . . . . . cel <br /> If not,explain: <br /> Applicatia : Apr / Denied Reason for Denial: <br /> Land Use: Date: <br />