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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> and/or Pre-Application Form Surveyof Existing arcel: 0.00/lot <br /> ]gyp Subdivision w//Survev: $20000.00+$50.00/lot <br /> era I c� Wac�rl cn� <br /> Owner: u n Buyer: „d <br /> Address: I�� 1 I b5 U V.�.. Address: E <br /> P' - <br /> &dqr ��7 vnL,5536g <br /> Phone: /�03 - OU -3 Phone: Z <br /> Orieinal Parcel Information qs- <br /> J?) <br /> J <br /> ParcellD#: 00—M-2-32-/6- 23- y Section d3 Township5q,/ Range <br /> 0'4- 000 - 0 IIO61 O <br /> Original Description (or attach copy): / / <br /> e1 (V 5F_ F— X PCL 5 � <br /> A <br /> _ Z C X CSmy Iy P2zo EX C' m <br /> V 2 Z_ 2- to <br /> p <br /> Current Zoning: 3 Floodplain Y/N: Wetlands Y6) <br /> 4 <br /> Lake/River Classification: Name of Water Body: <br /> Shoreland Agreemt or SIPS Y&_Farmland Preservation Y _Managed Forestry Law Y6-- <br /> New <br /> --New Parcel Inforrm � <br /> Information / ) <br /> Proposed New Legal Description and Parcel Size: e,$- .,t <br /> Y <br /> Acres: 2- <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: _ eh 0 G <br /> c 0. � m <br /> Proposed access to public waters to be provided Y6 <br /> If ves,describe access: J <br /> c 1 � 9 °Signature of Owner: Date: 1Ga r ! ZOi o <br /> o <br /> S <br /> 00 Signature of Owner: Date: o <br /> 3 <br /> ➢ Does parcel meet Zoning Requirements? �Y�. No e_') <br /> xt <br /> ➢ Does parcel require a Survey? Yes_ No h <br /> c � <br /> Z ➢ Permit application fees submii,, <br /> $ <br /> itted? ❑ Amount Yod Receipt# b <br /> ^ oa <br /> 0 <br /> a L <br /> El Reconciles with Real Property ListerYes No Date: <br /> If not,explain: <br /> W <br /> Applicatio Approved / Denied Reason for Denial: �. <br /> 0 <br /> d <br /> Land Use: Date: p <br /> 0 <br />