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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/or Pre-Application Form Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: D A O N E1 t_ Buyer: V <br /> A <br /> Address: loo g'( LOU Address: <br /> z <br /> k1�Bsrcf2. 1.Jr 5�1-893 ° <br /> Phone: 715- 9,&(c, 1391 Phone: w <br /> Original Parcel Information 9J <br /> Parcel ID#: A IT f*c N ur;, Section (j Township 3 9 Range�(� <br /> O <br /> Original Description(or attach copy): SE t l4 o F T 14EF N VJ t l q.- 5SEe1-1 o rJ 13 <br /> SavTH ot= C-T- X.r L.XG�PTr+JG THE W1 ST" Zeo' <br /> .o Current Zoning: V-_I_Floodplain Y/N: IJ Wetlands Y/N: Lake/River Class: -3 { <br /> ? "b <br /> e Name of Water Body: M0FJi-=N LR KG Shoreland Agreement/SIPS Y/N: N A <br /> Farmland Preservation Y/N: tJ Managed Forestry Law Y/N: rJ <br /> New Parcel Information O <br /> Proposed New Legal Description and Parcel Size: Co M Cil IJM I o EXI ST"J G PIN&CCLS <br /> tNTo T-WL) Nt�w LoTs BV GSM \J 33 f90 .5-1j-3`7 (O — <br /> Acres: I ce --t- <br /> (If <br /> = <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> SeTH I-°TS Ori CTH X d <br /> A <br /> Proposed access to public waters to be provided Y/N: N�h <br /> If yes,describe acre <br /> Signature of Owner: <br /> If�' o Date: 0 <br /> Signature of Owner:'�rA .tom �y' ""`� Date: <br /> 9 <br /> Kit➢ Does parcel meet Zoning Requirements. Yes No Q �1 ee <br /> a <br /> e ➢ Does parcel require a Survey? Yes No c <br /> J J <br /> -o' o <br /> 0° ➢ Permit application fees submitted? ❑ Amount$ Receipt# W 00 <br /> t. ❑ Reconciles with Real Property Lister Yes No Date: 4 <br /> e T 1 <br /> a If not,explain: w I` <br /> n W <br /> o � � <br /> n. c <br /> m o <br /> o r <br /> o , <br /> Application, Approved / Denied Reason for Denial: o & <br /> .D o <br /> Land Use: Date: <br /> 0 <br />