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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 /> /��� <br /> /��a/nd/or Pre/-Application Form Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: j0eayj W oc)d s 4A a�e r Buyer: ,.ty <br /> Address:��00�5 l f;�e Tr4'zC_ �P Address: 3 <br /> �rC��Jfsbure 1.�Z5z/8�o :°. <br /> Phone: Phone: 901) <br /> Orieinal Parcel Information <br /> 07-034-a-3�-Ig lI-S-OS-oos-OtJ000 �j ¢la <br /> Parcel lD#: O-7-o3tt-a-3,7-I$-Ia-SOSoo3-oI100o Section TownshipRange �g <br /> O <br /> Original Description(or attach copy): <br /> o� g3L�-a-3°�-l8-rr5-os-0o5 01( 000 -6oyLotS <br /> P <br /> 0'7 -o34- 0-3'7 -r8-ra- s-os-oo3-0!/000 = Gov Lv+- 3 � <br /> Current Zoning:QR-3 Floodplain Y/N: 1 e,5 Wetlands YIN: 65 Lake/River Class: I _ <br /> o Name of Water Body: \3�I rl-� LMt? Shoreland Agreement/SIPS Y/N: <br /> .o <br /> m AJ <br /> �q 1 O <br /> Farmland Preservation Y/N: C Managed Forestry Law YIN: No 0 <br /> New Parcel Information 1 d- <br /> Proposed New Legal Description and Parcel Size: P� ��a l �z�{s0 <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: p <br /> m <br /> Proposed access to public waters to be provided Y/N: <br /> Q <br /> If yes,describe access: <br /> Signature of Owner: Date: Q <br /> Signature of Owner: Date: o <br /> B <br /> c <br /> e <br /> ➢ Does parcel meet Zoning Requirements? Yes No A <br /> ➢ Does parcel require a Survey? Yes No t o s <br /> o' 7i5afzd-iin� r /a51.% -a.,d D-�fo � <br /> II // o � <br /> °° ➢ Permit applicationfees submitted? ❑ Amount$ Q`-f oO Receipt# i <br /> ❑ Reconciles with Real Property Lister Yes No Date: w <br /> � If not,explain: v .� <br /> A � � <br /> d <br /> PN <br /> Application: Approved / Denied Reason for Denial: ° O <br /> c � <br /> 0 0 <br /> Land Use: Date: <br />