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rcc> m..pmry <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 <br /> �Form Subdivision w/Survey: $200.00+$50.00not <br /> Owner: M tC hg-C� / A Ca r Sd/ Buyer: b <br /> Address: U '9 Ca) jral 144 - Address: 3• <br /> Phone: lS� JS ���� Phone: <br /> Original Parcel Information '/ d <br /> Parcel ID#: �� U - T II o�D� �C�Z� Section C- Township N Range <br /> O <br /> Original Description(or attach copy): <br /> 5'0--e- <br /> > <br /> et> _ <br /> e <br /> on Current Zoning: 4-L3— Floodplain Y/N: All-) _ Wetlands Y/N: �! <br /> Lake/River Classification: Name of Water Body: <br /> Shoreland Agreemt or SIPS Y/N: Farmland Preservation Y/N:_Managed Forestry Law Y/N:_ <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: w 2 a Q Ft EY-( �h -0- wQs� y o 40s5,:!5- z� o *' <br /> -57Q / <br /> C- ' / 62 1- 4�3 P /C (q w SCu-ff Acres: 5-S <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: r� d <br /> d <br /> Proposed access to public waters to be provided Y/N: /t✓J 1 <br /> l <br /> If ves,describe access: <br /> p <br /> Signature of Owner. 1 Date: 1 " �' CJ �) <br /> � <br /> C4 <br /> Signature of Owner: Date: <br /> 7 <br /> C <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> ➢ Does parcel require a Survey? Yes No <br /> as � <br /> D Permit application feu submitted? ❑ Amount$ Receipt# <br /> ro ❑ Reconciles with Real Property Lister Ygs. No Date: <br /> e \\Sl <br /> � <br /> a .� / <br /> If not,explain-IL / Stn g Lvt 61 MY lex- Li—r+ <br /> o <br /> N <br /> Y � <br /> Q <br /> Applicatio Approved / Denied Reason for Denial: /� �j a <br /> Land Use: Date: % gZ71 <br />