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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/orPr�e-ApplicationForm Subdivision w/Survev: 5200.00+$50.0011ot <br /> Owner: fYl (C11q-e / <br /> / /'i Ca r S /-`Bs uyer: <br /> Address: / p onalk t Address: B• <br /> Phone: l J S O r / D Phone: w <br /> Original Parcel Information <br /> Parcel ID#: ba� ��(a`�.�'��b Section C- Township' /� Range <br /> O <br /> Original Description(or attach copy): <br /> A <br /> See !V61CCA <br /> v <br /> g <br /> oCurrent Zoning: 3 Floodplain Y/N: AZO _ Wetlands Y/N: <br /> Lake/River Classification: Name of Water Body: <br /> Shoreland Agreemt or SIPS Y/N: Farmland Preservation Y/N:_Managed Forestry Law Y/N:_ <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: W a 54- a Q R N S <br /> U -f %/--A ,e u/05%E 20 -0 'f'Gt -e <br /> SQ C_ • la 'r 40 & /C (C/ Q./ S�u� Acres: <br /> (if parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: V-a rP— <br /> C <br /> w <br /> Proposed access to public waters to be provided Y/N: /'✓J <br /> ._Z) <br /> If ves,describe access: <br /> Q <br /> Signature of Owner: Date: <br /> Signature of Owner: Date: 3 <br /> v <br /> e <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> ➢ Does parcel require a Survey? Yes No a <br /> va <br /> Permit application fees submitted? ❑ Amount$ Receipt# Oe <br /> m ❑ Reconciles with Real Property Lister ` Ye No Date: <br /> o / <br /> If not,eaplain'jgA ;?CD f S I.-i_ a 4,/111 NOT <br /> o y �w <br /> a — ` <br /> N w <br /> Y _ o <br /> Applicatio Approved / Denied Reason for Denial: <br /> Land Use: Date: <br />