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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 or Map Review Form Subdivision w/Survev: $200.00+$50.00/mt <br /> Owner: M 4rz,� PVrErzSot J Buyer: 3 <br /> Z <br /> Address:_ ZCv`az3 tom . Z7D. Address: <br /> �C ��SSTE2 LVI S4 <br /> Phone: —I r -Co3 5 ' -1 Zs�c Phone: <br /> Original Parcel Information <br /> Parcel ID#: 07 10 Sn zze) Section S Township Range ( 4 m <br /> Original Description(or attach copy): t':244Z—: <br /> Current Zoning: I/� / <br /> g:�lz Z Floodplain I�I Wetlands xt/tv:/ Lake/River Class: <br /> D Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> 9 <br /> Farmland Preservation I /N� Managed Forestry Law <br /> o �' , / <br /> New Parcel Information V, 03 74q <br /> Proposed New Legal Description and Parcel Size: 'lJ-E W LGS M I I '/Z- A e_m_ S <br /> A-2O v I r7 't>A f--- o L'p ( _At. t-I o o L- - <br /> Acres: �z_. ALR E'Li <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> � / A <br /> Proposed access to public oa (sASL f�� G Z Er= 20 Apr <br /> 1��5 <br /> Proposed access to public waters to be provided YIN: IS- <br /> ti � <br /> If yes,describe access: 9j <br /> o <br /> Signature of Owner: Date: 0 clk W � <br /> Signature of Owner: Date: � <br /> m <br /> ➢ Does parcel meet Zoning Requirements? Ye No K To Su- Ty xt <br /> 9-ao-ra I <br /> ' D <br /> N ➢ Does parcel require a Survey? Ye No � <br /> 1 � <br /> ➢ Permit application fees submitted? Amount S ahb.1�0 Receipt# w <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> r OI <br /> � If not,explain: <br /> a v <br /> o Q ( <br /> a Applicatio Appr / Deni d Reason for Denial: q rVvf! <br /> Land Use: Date: �— <br />