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Burnett County Subdivision Pernnit Application <br />and/or Pre -Application Form <br />Owner: �Cfi/4FG FU �2 Buyer: <br />Address: �Jr✓� �. Address: <br />S&�cSTA u G . /1%% S"SoyS <br />Phone: C.t 51 Z35--;7zw Phone: <br />Pecs (nmst accompany form): <br />Subdivision w/o Survey: $50.00 <br />Survcy of Existing Parcel: $50.00/lot <br />Subdivision w/ Survev: $200.00 + $50.00/lot <br />B OHL-,final Parcel Information <br />Parcel ID #: � -3T z �'y'j�0 s Z y�,i8 Section z % 'Township 37 Range /6, <br />Original Description (or attach copy): 467 9 G6T /O Lp r/f <br />Current 'Zoning: t?k Z Floodplain <br />/Y,,/N:�____Wetlauds Y/N: /V Lake/River Class: L--� <br />N;.sae of Water Body: Por.'p zwef — Shoreland Agreement/SIPS Y/N: A <br />F, ru land Preservation Y/N: N _Managed Forestry Law Y/N: /AV/ <br />New Pa.-ccl Information <br />Proposcd New Legal Descripti • lid Parcel Size: <br />412c e4 41.71 <br />Acres: qc . <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />:'reposed access to public road: Z)R,Proposed access access to public waters to be provided Y/N: — <br />If yes, describe access: <br />Signature of Owner: <br />Signature of Owner: <br />Dale: <br />Date: <br />Y Does parcel nneei Zoning Requirements? 1 es No <br />Y Does parcel require a Survey? <br />),� Permit application fees submitted? <br />❑ Reconciles with Real Property Lister <br />If not, explain: <br />} es No <br />Aiuouni $-15LReceipi # <br />Yes No Date: <br />Application: Approved / Denied Reason. for Denial: <br />Land <br />Da <br />ECE, WE <br />FEB zi ian <br />J <br />BURNETi COUNTY <br />ZONING <br />