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Ks <br />Fees (must accompanv fonnl: <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 Subdivision w/ Survev: $200.00 + $50.00/lot <br />Owner: Je f �x U e l Ac�,_ Buyer: ,9 <br />i ` n <br />Address: '70 l l �S 1aTe J�d 20 Address: 3 <br />Phone: %3 Phone: <br />Oriainal Parcel Information v <br />Parcel ID Section Township 3&- Range /(p 0Q, <br />/ <br />nn O <br />Original Descriptien (or attach copy): YcIsre [TclC), .t <br />Current Zoning: —Floodplain V N�Wetlands �N�iLake/River Class:_ <br />Name of Water Body: /tJ A Shoreland Agreement/SIPS X N� `\ <br />.. Farmland Preservation 1(/N: Managed Forestry Law Y �U <br />New Parcel Information <br />1 , go - <br />Proposed New Legal Description and Parcel Size: -2 LD + C 5 m <br />Acres o I Z <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road:. <br />m <br />Proposed access to public waters to be provided <br />If yes, describe access: Uj <br />l � <br />Signature of Owner: Date: <br />Signature of Owner: Date: e <br />> <br />Does parcel meet Zoning Requirements? Yes :Vo <br />e <br />N � <br />,Does parcel require a Survey? Yes Ao <br />5' <br />0° > Permit application fees submitted? Amount $ _3DL Receipt # <br />�. ❑ Reconciles with Real Property Lister Yes No Date: <br />d <br />0 <br />a If not, explain: <br />CEOVEA <br />0 <br />c. <br />Vi <br />Applicatio pproved / Denied Reason for Denial: <br />Land UDate: ZONING <br />f� -62 S8"'7 <br />