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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: $50.00Hot <br /> ,,tt4T�� <br /> and/or Pre-Application Form Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: J t5D L t&4-t;-ry— Buyer: �p <br /> m <br /> 3 <br /> Address: i 1 33'�' /`t A�6AT"I�d �� Address: <br /> z <br /> L L..)L.r- <br /> Phone: sz-7 — Phone: U <br /> Orieinal Parcel Information U l <br /> Parcel ID#: b341 - 1535 -O/ G00 o4eme 700 Section 35 Township 37 Range I $ <br /> F <br /> Original Description(or attach copy): � <br /> m <br /> Llt <br /> .o Current Zoning: A['1 " Floodplain Y/N: N Wetlands Y/N: tJ Lake/River Class: NA <br /> ,0 O1 <br /> 1 <br /> Name of Water Body: N A Shoreland Agreement/SIPS Y/N: N'Q <br /> .. Farmland Preservation Y/N: _11Managed Forestry Law Y/N: I V <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: SEE E A T-T-A&UM <br /> Acres: /O ACizr 5 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: �jl a- L. 7DJt d <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: 41 <br /> Signature of Owner: Date: <br /> Signature of Owner: Date: 3 <br /> 9 <br /> e <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> ➢ Does parcel require a Survey? Yes No J <br /> Q0 ➢ Permit application fees submitted? ❑ Amount$ Receipt <br /> t„ ❑ Reconciles with Real Property Lister Yes 1 No Date: ) <br /> W 6J <br /> m � <br /> a If not,explain: A <br /> F <br /> 00 Do <br /> o VI IJ <br /> 'a i tf, <br /> y ^1 <br /> xll F'! <br /> Application: ( Approve Denied Reason for Denial:_ [sort/ AOJ D <br /> ' � g O <br /> Land Use: Date:jn -, �1-1� Q <br /> O <br /> e o <br /> O P <br />