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Fees(must accompany form): <br /> Burnett Count Subdivision Permit/Survey Review Subdivision w/o Survey: $50.00 <br /> County Survey of Fxisting Parcel: $50.00/lot <br /> Application and/or Pre-Application Form Subdivision w/Survev: $200A0+$50.00/10t <br /> b <br /> Owner: t-77 <br /> w s Buyer: n <br /> Address: Address:jiru � <br /> Phone: /J + Phone: w <br /> V D' .3.3_ Original Parcel Information <br /> v5-oor oZ/000 <br /> Parcel ID#: 6z2� Section 3 Township �A Range C <br /> 0 <br /> Original Description(or attach copy): _ <br /> �Q �' N; Lake/River Class: <br /> Current Zoning: r 1/t-n� Floodplaii�/N: Wetland <br /> Y Name of Water Body: Shoreland Agreement/SIPS Y6L _ <br /> Farmland Preservation Y Managed Forestry Law Y <br /> New Parcel Information J <br /> _ ,j LD7 <br /> Proposed New Legal Description and Parcel Size: W <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> :1 <br /> Proposed access to public road: �`'�-� /I�T/U • � � � <br /> � UJ <br /> Proposed access to public waters to be provided Y/6 <br /> O <br /> If yes,describe access: <br /> � I) <br /> Signature of Owner: Date: — gj <br /> Signature of Owner: <br /> Date: 9 V <br /> F <br /> 30Does parcel meet Zoning Requirements? Yes No <br /> R <br /> o ➢ Does parcel require a Survey? Yes No /�f�Q 511 <br /> 00 ➢ Permit application fees submitted? Amount 36D`00 Receipt# <br /> t„ 0 Reconciles with Real Property Lister Yes No Date: <br /> 7 <br /> a If not,explain: <br /> E <br /> 511 Approved / De ied Reason for Denial: <br /> 2 �� <br /> Land Use: Date: B PNETT COUNTY <br /> ZONING <br />