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Fees(must accompany forth): <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+$50.00/lot <br /> Owner: ��v 0 tzE-� D , M 00 r-C Buyer: a <br /> A <br /> 3 <br /> Address: 544iv Po,,J-r FuA.o Address: - <br /> 0 <br /> Phone: -==m� S-1 -Qj9Q� - Phone: <br /> OriOual Parcel Information 1 <br /> Parcel ID#: 0204 12.Z O3 Z o C> Section 2Z Township 40 Range l t <br /> /� q O <br /> Original Description(or attach copy): FAr_r off' yz ,,kr Loa: 5 <br /> EL r t o t-1 22 -7 4o ttJ TZ 1� `-o w ,-1 6 Sc e)-r-r <br /> L'�U2t-A t n--v- Cd "I-rye V,I (La tits',_l . <br /> Current Zoning: QR3 Floodplain °/N Wetlands /5 Lake/River Class: <br /> > Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> m Farmland Preservation Y/N: Managed Forestry Law Y/N: ^ <br /> New Parcel Information csm V, a Ll to <br /> Proposed New Legal Description and Parcel Size: 30 X ± Z e) A 2ES� <br /> 1 � <br /> Tt� E �E Coz�12 � DF G- <br /> L . 'S J>=LTZ 3 Y <br /> / � a <br /> TZ,o r`� _ (214 \^I ( �lra, tik..V Gsti) Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) V <br /> Proposed access to public road: 74271 y Ar-r£ S v m 14 Y1_�b 17 d <br /> Proposed access to public waters to be provided Y/10 <br /> If yes,describe access: <br /> Signature of Owner: Date:1 / /G'�'T� Date: ��/df j o 6^ <br /> O <br /> Signature of Owner: Date: 3 <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> /0_(q-tJ <br /> ➢ Does parcel require a Survey? Yes No <br /> ➢ Permit application fees submitted? ❑ Amount$ �5�' GO ReceiptCP <br /> # <br /> t" ❑ Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> O <br /> a o1 <br /> y RY <br /> Application: (!pproved Denied Reason for Denial: <br /> Land Use: Date: <br />