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Fees(must accompany torm): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> /�/a�OO��a��yyn,,��d/or Pr--e/--A/ppli/c�at/ion Form Subdivision w/Survev: 5200.00+$50.00/lot <br /> Owner: //f/7 C JALL 4- G�L]/J� 7"lILL Buyer: .d <br /> Address: ,36a ! 5 2Nd T1 E A/ Address: <br /> W ! <br /> Phone: 115- 6-656 3156 S / 3 Phone: <br /> 0/7-63k Z -gl-lb 2�_5 Orieinal Parcel Information VQ <br /> lS-dbq_ oN5/d60 — / ,,/ <br /> Parcel ID#: N50G2� - UyLLd -d Y'?GVO Section 28 TownshipJs_/'W Range /0 t V o <br /> Original Description(or attach copy): E o�5 ze f 15 <br /> A <br /> L-6-r5 6-1,1 aF Blsc 3 .1VIZAt vF O1v,6�Mzy <br /> 5W N,e FXiMAL 6 P,+kC645 <br /> d Current Zoning: t,` Floodplain YWetlands 1Y49 <br /> Lake/River Classification: Name of Water Body: 4 <br /> Shoreland Agreemt or SIPS Y49 Farmland Preservation)o_Managed Forestry Law Y(9 <br /> New Parcel Inforrmattion� <br /> Proposed New Legal Description and Parcel Size: &7:5 / V . �� �• I�h <br /> Acres: . t0� <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: PI-ILLY Aa_t t tG <br /> Proposed access to public waters to be provided <br /> Y/6— <br /> If <br /> / I:If ves,describe access: <br /> Signature of Owner: \\ 1 1 Date: a <br /> Signature of Owner: �IJJ71_A t� C+ Date: 3 <br /> v <br /> e <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> 0 <br /> ➢ Does parcel require a Survey? Yes No <br /> ao � � V7� 0 <br /> Permit application fees submitted? 11 Amount S x.50 D Receipt# Vi <br /> ij <br /> t ❑Reconciles with Real Property Lister Yes No Date: <br /> 710 <br /> a <br /> If not,explain: <br /> U <br /> 0 <br /> c rV^1 <br /> _1 <br /> 0 <br /> Application* Approved I nied Reason for Denial: { <br /> Land Use: �� — Date• k $$ d o <br /> 0 0 O o <br />