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Burnett County Subdivision Permit Application <br />and/or Pre -Application Form <br />Fees (must accompany form): <br />Subdivision w/o Survey: $50.00 <br />Survey of Existing Parcel: $50.00/lot <br />Subdivision w/ Survev: 5200.00 + $50.00/lot <br />Owner: �„o <br />v� 2 , e v�- SU v\ <br />Buyer: T�1U <br />uS IJ�C ,in P iJ, ��2e <br />Address: 1 <br />I a C <br />Address: 1203 <br />J'Gt v� v L r, <br />f redes-, c,)1 -5-q837 <br />Phone: `Z/ 51 -3,22 - L - 5- <br />G y0 <br />Phone: `715-` 3;;2 %- 5 71 <br />7 c 3 N -d 31 ► dfs-i v 3 -ORS �'liGt7� Orilzinal Parcel Information <br />Parcel ID #: Section-2-L—TownshiP7 Range J� <br />Or;-.inal Description (or attach copy): C'- ca ��ce e- c <br />Current 'Zoning:A L*'R 6 Floodplai Y ___Wetland Y/ f: Lake' River Class: <br />Name of Water Body: Pi c_ k le L_"_k 0 Shoreland Agreement/SIPS V�N� <br />Farmland Preservation V/ % Managed Forestry Law Y/N: <br />New Parcel Information 05n] V a(o � g 9 <br />V" <br />Proposed New Legal Description and Parcel Size: /�.� �. 46 '� 4f_5 m <br />Ct v, r� 'i- Ick J e <br />Acres: / S <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: '�-X t '-)J <br />Proposed access to public waters to be provided Y/N: <br />If yes, describe access: <br />Signature of Owner: Date: ! �} <br />Signature of Owner: Date: <br />N <br />c <br />0 <br />�a <br />r <br />a <br />c <br />ro <br />n <br />0 <br />w <br />u. <br />o Does parcel meet Zoning Requirements? <br />Does parcel require a .Survey? <br />i Permit application fees submitted? ❑ <br />Yes Vo <br />Yes No <br />o� <br />Amount S 3 00. Receipt # <br />❑ Reconciles with Real Property Lister Yes No Date: <br />treason for Dental: <br />