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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 /> and/or Pre-Application Form Subdivisionw/Survev: $200.00+$50.00/lot <br /> Owner: C.�I —T-NOyWI As Buyer: <br /> ro <br /> Address: 7 6(Z&DFbrlj) AVE7, Address: <br /> CXj <br /> �� aw►pt_t TV�rJ SS31 � <br /> Phone: Phone: <br /> GO <br /> Original Parcel Information <br /> 6Z6 -3231 - a$>cp �^, <br /> Parcel ID#: (516 6 0 Section S 1 Township�Range <br /> p O <br /> Original Description(or attach copy): Dzeds, V, Z -/ <br /> ro <br /> Army, 270 o yo2- <br /> e Current Zoning: r 1� _ Floodplain Y0 Wetlands Y/ <br /> Lake/River Classification: NIS Name of Water Body: <br /> Moreland Agreemt or SIPS YoN- Farmland Preservation Y Mana¢ed Forestry Law YA <br /> O <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Si2x: LL L..\�� (f cis-re'-7-1 y �1 <br /> ey <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: bt12ECr A at��c6s A" D G re^_c-€/1/1i 1 <br /> m <br /> m <br /> Proposed access to public waters to be provided Y/N: L)9 <br /> — <br /> If ves,describe access: <br /> e Signature of Owner: Date <br /> Signature of Owner: Date:7?/,tG <br /> r a <br /> ➢ Does parcel meet Zoning Requirements? Yes No T S <br /> t' ➢ Does parcel require a Survey? /7�Yes <br /> No <br /> p / o <br /> �d ➢ Permit application fees submitted? ❑ Amount$ t>LD 0' o D Receipt# <br /> 0 <br /> y ❑Reconciles with Real Property Lister Yes No Date: <br /> rr <br /> If not,explain: w <br /> p o <br /> Application: Approved / Denied Reason for Denial: o b <br /> gv <br /> a P <br /> J <br /> Land Use: Date: <br /> 0 <br />