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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: $50.0011m <br /> and/or Pre-Application Form Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: �ar1 - floe�on S�yac Buyer: A <br /> Address: \\\n 0 Cr c c�v 1 v\ Gam. Address: 3 <br /> Z <br /> 2369 SlhlT-1f Rev <br /> UJ <br /> Phone: Phone: 4j <br /> D26o°,611(v1Z,611tb22Original Parcel Information <br /> Parcel ID#: O\�p- 3`l'2�1- Y)2 60 S Section�_Township�_Range�_ C <br /> Original Description(or attach copy): C 5'rr V 2,0 }� :k g - :L. <br /> esrr, �1 2� � vrt,es 131e- 137 ��Ps 1v-'ll ati�f L„i's <br /> w Current Zoning: Floodplain Y& Wetlands6% S <br /> Lake/River Classification: Name of Water Body: — o <br /> 0 <br /> Shoreland Agreemt or SIPS Y&: Farmland Preservation Y,t�1 =Managed Forestry Law Y&*= <br /> New Parcel Information y� <br /> Proposed New Legal Description and Parcel Size: I Lot CtjyT:,d fyVvtjt AMP <br /> Acres: 30 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Ex i t iftj6o d <br /> Proposed access to public waters to be provided Y& <br /> C)J <br /> If ves,describe access: j <br /> i <br /> d <br /> N Signature of Owner: Date: DQ <br /> 0 <br /> e <br /> n <br /> °Q Signature of Owner: Date: 3 <br /> e <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> x <br /> ➢ Does parcel require a Survey? Yes No a g g o p 0 <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# 1�� / I w <br /> a fu W W W S� Ai <br /> y ❑ Reconciles with Real Property Lister Yes No Date: Z c c <br /> ' ' o <br /> If not,explain: <br /> 6�Ga <br /> Applicati . A enied Reason for Denial: <br /> Land rt //ill-lam/ <br /> Date: *-3` 3"0 <br />