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Pees(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+$50.00/lot <br /> Owner: ZOEr'E 2 2T___bE Buyer: <br /> 'o <br /> A9- re <br /> Address: Z64Zgd� LlPS�'rT ZX-, A9- Address: <br /> sPoon/6YIi c,Jl - S`f Fs0( z <br /> 0 <br /> Phone: 7/5- 417/3 Phone: <br /> Orieinal Parcel Information �--- <br /> Parcel ID#:07 aZ,�-Z•5?-/�f^IZ SoS od/-CS//00/ Section 1 Z Township 3-'J Range 1 G <br /> O <br /> Original Description(or attach copy): <br /> X479,ZZ/T_75L <br /> O <br /> Current Zoning: I Floodplain Y/N:�Wetlands Y/N:�1 j Lake/RiveerrCClass: I <br /> 9 Name of Water Body: ` I Ps t Shoreland Agreement/SIPS`8/N:I 7) <br /> Farmland Preservation YM <br /> anaged Forestry Law Y <br /> 0 <br /> New Parcel Information 7Z <br /> — <br /> Proposed New Legal Description and Parcel Size: G5ng 0Vvi LcrrS <br /> 4 <br /> Acres: -12 E, <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) 1 <br /> Proposed access to public road: t�� (J�Jt r-_- {SC-ME-t-f Fe-1 d <br /> Proposed access to public waters to bte-`provided Y/N: \o0X- m p_, t=(za,,AT o -TS <br /> GQ <br /> If yes,describe access: <br /> i <br /> Signature of Owner: Date: 7i?`f Zo/� p <br /> .eeoe✓— <br /> Signature of Owner:KC�BC-rer *.S'.f�Aeljq017r06- ,By� a2. Date: 7-Z4—Zolp o <br /> ' 3 <br /> 'O <br /> ➢ Does parcel meet Zoning Requirements? Yes No elC J/kS d A <br /> ➢ Does parcel require a Survey? Yes - No 0 <br /> J <br /> 00 ➢ Permit application fees submitted? ❑ Amount$�kb, 0 D Receipt# o <br /> su <br /> t. ❑ Reconciles with Real Property Lister Yes No Date: 9' <br /> m w <br /> If not,explain: <br /> 0 <br /> a � <br /> N �^ <br /> Application: Aro Denied Reason for Denial: <br /> 8 <br /> ° <br /> Land Use: Date: <br /> 0 <br /> 0 <br />