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Fees(must accompany Corm): <br /> Burnett County Subdivision Permit/Survey Review Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> Application and/or Pre-Application Form /� l Subdivision w/Survev: $200.00+550.00/lot <br /> Owner: L 1 �� l7 Lea !J�' B - e, / ,,t 6 LeQ SOy�- ro <br /> /, /, ' % /t d <br /> Address: /j,/�I�2 v� /�ci tel. Address: ���t/ � u <br /> �,n,/�-ct�tc, ��✓i//' �yS3d ��ir t `�1� 5y83o z <br /> 0 <br /> Phone: 1 t 866- M7 Phone: <br /> o ri mal arcelInformation <br /> r0,'7-020- 2�'!0 /b-Z/ Ol 03000- o �IIc✓d �/ ,/ / / 1 <br /> Kneel ID#: �.[y2h- � �D /lo Z/-Dl r 3 _ Section �� Township Wk/Range �/j IV p <br /> Original Descri tion(or attach copy): C AlW E 10C /itJ i <br /> pea 3 W 3y� [ j cam ) N E X V; 3o P626 21 r- <br /> Current Zoning: Floodplain YI(pI/. Wetlands Y.9I Lake/River Class: <br /> Y Name of Water Body: '� Sboreland Agreement/SIPS Yo <br /> Farmland Preservation Managed Forestry Law <br /> New Parcel Information �(Y\{,V, <br /> Proposed New Legal Description and Parcel Size: `5'w _C4/�/ /Aj <br /> Acres: 3M <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C�l�j 2d U d <br /> A <br /> Proposed access to public waters to be provided Y(1C- <br /> Ln <br /> If yes,describe access: <br /> Signature of Owner: r Dater —9 9—l�— o) <br /> Signature of Owner: Date: / <br /> 'o <br /> 5 7'tJ c <br /> ➢ Does parcel meet Zoning Requirements. Yes No n <br /> a <br /> 7 ➢ Does parcel require a Survey? Yes No <br /> d <br /> Permit application fees submitted? Amount$_3 <br /> Receipt# � <br /> r Reconciles with Real Property LiK YesNo Date: <br /> 7 C9 <br /> If not,explain: <br /> COU <br /> fE �I <br /> d N <br /> Application: Approved / Denied Reason for Denial: U\j <br /> Land Use: Date: <br />