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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 /> dd <br /> and/or Pre-Application Form Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: �/J�571/7� 171100Y171100Yj 'LL Buyer: <br /> Address: •30L /n6 2—AC( AVE /V Address: � <br /> Phone: / l�' !U �Xi— .� �JO Phone: <br /> 0'76"3Z Z -g1-16 l y> Ori2inat Parcel Information / <br /> /j-C:6�/- 6glc — �V <br /> ParcelID#: rt c/ SCCC C)y65 _CY'1�06 Section Township y//V/ Range & <br /> LL tt O <br /> Original Description(or attach copy): L L6 f �5 CL�t <br /> 6 E 3 <br /> div N1= // p <br /> m Current Zoning: l�2 Floodplain Y& Wetlands N& <br /> .. Lake/River Classification: Name of Water Body: <br /> Shoreland Agreemt or SIPS Y&Farmland Preservation 16-_Managed Forestry Law Y&_ <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: + <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: i�l ilJXy' T d <br /> m <br /> Proposed access to public waters to be provided Y/6 <br /> If ves, describe access: <br /> Signature of Owner: Date: <br /> Signature of Owner: Date: 9 <br /> o <br /> Se�Ua�t�M al"12, <br /> ➢ Does parcel meet Zoning Requirements? Ye No � <br /> ➢ Does parcel require a Survey? Yes No <br /> ao <br /> D Permit application fees submitted? ❑ Amount$ Receipt# <br /> r ❑ Reconciles with Real Property Lister Yes No Date: <br /> d <br /> a <br /> If not,explain: <br /> n <br /> 0 <br /> c <br /> v, <br /> Applica 'on: Approve Denied Reason for Denial: Bic Idr4axr"e— <br /> Land Use: Date: <br />