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Fees(must accompany Corm): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> nn <annd/or Pre-Application Form Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: Mn^�--�f/ LL 4- �Qy j/I Ll— Buyer: <br /> Address: 3oa / 6 2Nd 411E tip Address: g <br /> VV) <br /> Phone: 715- t0,56 3 156 r3 Phone: <br /> r077-6 3Z-a -////b z 9-5 Orieinal Parcel Information <br /> 15-ooy- oyyoao — �/ ' ' ,/ <br /> Parcel ID#: -0--!i 1j - 0'16W6 -6WOW Section26 Township 4,/,/A// Range /4 t V O <br /> Original Description(or attach copy): E a 5 [4 f 15 <br /> n, <br /> Lorts -lSl b F '6/K 3 `'L, oP zwmz y <br /> 5W HE Fi(15-UA16 PIMC6 <br /> ON Current Zoning: I\ Floodplain YO Wetlands o <br /> Lake/River Classification: Name of Water Body: --- 4 <br /> Shoreland Agreemt or SIPS Y6—Farmland Preservation%S)_Managed Forestry Law Y(9 <br /> New Parcel Information\ <br /> Proposed New Legal Description and Parcel Size: V I �• /lO'l /T TT <br /> Acres: 4 (O� <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 1'1 ILIAD 0 1 �G <br /> Proposed access to public waters to be provided Y/6-- <br /> If <br /> / T:If ves,describe access: <br /> Signature of Owner: Date: <br /> Signature of Owner: AA Y-� Q Date: o� <br /> e <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> 0 <br /> ➢ Does parcel require a Survey? Yes No <br /> ao T 0 <br /> Permit application fees submitted? 11 Amount$500•V V Receipt# Vii <br /> x; <br /> t ❑ Reconciles with Real Property Lister Yes No Date: c <br /> c e <br /> If not,explain: <br /> 1j <br /> 0 <br /> o. rY^1 <br /> '1 <br /> 0 <br /> Application, Approved / nied Reason for Denial: { <br /> �a d� <br /> Land Use: Date: �� �� k g o 0 0 <br /> 00 0 a <br />