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Fees (must a"Ornpany Corm); <br />Burnett County Subdivision Permit Application Subdivision W/0Survcy 540.00 <br />Survey of Existing Parcel; $50.00Aot <br />and/or Pre—Application Form SubdivisionwlSurvev: S20000+S30.00'10t <br />` 'r i <br />Owner: o l�txv Buyer: <br />Address:` `�` Try Address: L <br />51 <br />Phone: Cela - l 33 7 9 Phone: <br />Original Parcel information <br />Parcel ID#:raj-o3CS-d-yl_ty-tlo-S-,C0;;;i_2jf,,,Section___L�a Township iii Range_l_-- G <br />41- <br />Original Description (or attach copy): 4 G L) t P <br />3g3y3 <br />(Gno 1_64a-k-3� (sLt^ <br />Current Zoning: ��_Floodplainl: Wetland Y Lak /River Class: <br />2 Name of Water Body: W --Shoreland Agreement/SIPSS)NL _ ----- <br />.. Farmland Preservation YR Managed Forestry Law Y Y/ : <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: A) o w v2 /_04 CS VV1 <br />Acres: 1`%.y2 <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: -� I q <br />Proposed access to public waters to be provided Y/N: <br />If yes, describe access: <br />Signature of Owner: <br />Signature of Owner: <br />> Does parcel meet Zoning Requirements? Yes <br />v Does parcel require a Suivey? Yes <br />> Permit application fees submitted? ❑ ,4mount S <br />No <br />No <br />Date: l(l /I I <br />Date: <br />Receipt 4 <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />Application: Approved / Denied Reason for Denial; <br />Land Use: Date: <br />