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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: $50.00Aot <br /> and/or Pre-Application Form Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: Sohn ani ?(J('6C, k(\GeII Buyer: ., <br /> m <br /> Address: 2 )-10 Lan n c, U'V e- k oQ A Address: <br /> We66 La Xe . wi SU9301 o'J <br /> Phone: (S 2 S t} 1 $ Phone: Y 1 <br /> OriP.inal Parcel Information <br /> 01- 000 - 0tt000 <br /> Parcel ID#: Z- 40-15- 01-4 Section I Township L43- Range IS <br /> `` p� r � 1 SOS <br /> Original Description(or attach copy): IV e7' S E e g ce p+ �la� o T \A-,I d , Ce -N6" p <br /> R <br /> £xl"rr,tit fa5� � <br /> •o Current Zoning: RR- 2 Floodplain Y/N: N Wetlands Y/N: Lake/River Class: <br /> q <br /> m Name of Water Body: f�o n e Shoreland Agreement/SIPS Y/N: <br /> Is <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Information CSrn V <br /> Proposed New Legal Description and Parcel Size: Two WS -J-6f IS 5 At re1 <br /> N <br /> and A-C nilvri ; S 3 Ades <br /> S And <br /> Acres: 3 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Lor $ o pe- (3r\ Loon Lotkt' Zo wAs O <br /> m <br /> A <br /> Proposed access to public waters to be provided Y/N:� J <br /> If yes,describe access: <br /> Signature of Owner: filDate: (0 , <br /> / <br /> Signature of Owner: - Date: (0. <br /> 9 <br /> C <br /> ➢ Does parcel meet Zoning Requiremenfs? Yes No <br /> N � <br /> °o )o Does payeel require a Survey? Yes No <br /> 0 <br /> 00 ➢ Permit a lication es submitted? ❑ Amount$30 0. 0 d <br /> pp fe Receipt# q� <br /> v <br /> t- ❑ Reconciles with Real Property List Yes No Date: <br /> If not,explain: + o� <br /> n <br /> a 4 <br /> 0 <br /> Application( Approv / enied Reason for Denial: <br /> / 0 <br /> Land Use: Date: <br />