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Fees (must accompany form): <br />Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br />and/or Pre -Application Form <br />SurveyofExisting S20 .0.00/lot <br />pp Subdivision w/ Survey: $_00.00 + $50.00/lot <br />Owner: I O Dex w e t�0.Y-% Buyer: <br />Address: 299a 5�' f. IZc� �t7 Address: <br />cvs sL <br />Phone: (o Fsl9'_ 3399 Phone: <br />Original Parcel Information <br />Parcel [D#: d--rz0a-2tQection i�- Township y/ Range1� <br />Ori incl Descri tion (or attach co ) L^4 J -Sm^ i) )i (* :?%--Z42sA <br />g p PY _ <br />CG-ou k&k <br />f <br />Current Zoning: Floodplain ./N: Wetland�VN: _ (Lake/River Class: <br />Name of Water Body: Shoreland Agreement/SIPS 1)N: <br />Farmland Preservation Y <br />Managed Forestry Law Y/N: <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: )j 0e _6 I C�� IN\ <br />Acres: LL, y 2 <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road:�� <br />Proposed access to public waters to be provided Y/N: <br />If yes, describe access: <br />Signature of Owner: <br />Date: <br />Signature of Owner: Date: c <br />3 <br />> Does parcel meet Zoning Requirements? No ° <br />A <br />N � <br />> > Does parcel require a Survey.' Yes No <br />Permit application fees submitted? Amount S . tV Receipt 9 <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />Application( pprov Denied Reason for Denial: <br />Land Use: <br />Date: BURNETT COUNTY <br />