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Fees (must accompany fonn): <br />Burnett County Subdivision Permit Application Subdivision w/o Survey: S50.00 <br />Survey of Existing Parcel: S50.004ot <br />and/or Pre -Application Form Subdivision w/ Survev: 5200.00+$50.00/lot <br />Owner: A m e s P241 '5cM Buyer: <br />Address: a 3 ��1? Pe-IIff Se,^, �� Address: <br />5'tre;n <br />Phone: '%/S- ,3` j- Phone: <br />Original Parcel Information <br />o7-�"a-3$-17-tis v3=ct,i-oiler <br />ParcellD#:�7"cob-d"?�-r�-t3-t �/"'``'It' Section—L-3Township 38' Range <br />Original Description (or attach copy): 6 I Ex 3a/ 0 V %o 6&0" [_,c `i7�f14,4 <br />Current Zoning: AR Floodplai► Y/ : Wetlands Y N: Lake iver Class: <br />Name of Water Body: "� ockShoreland Agreement/SIPS Y/N: <br />Farmland Preservation Y(N:) Managed Forestry Law <br />New Parcel Information�o—��'� <br />Proposed New Legal Description and Parcel Size: /V ec,) 3 ke CS rn <br />Acres: 72, D <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 />/ /7 <br />Signature of Owner: �� �/t�c, Date: <br />Signature of Owner: Date: <br />> Does parcel meet Zoning Requirements? Yes No <br />> Does parcel require a Survey? Yes No <br />°0 > Permit application fees submitted? ❑ Amount $ -J 5 Receipt # <br />t.. ❑ Reconciles with Real Property Lister Yes No Date: <br />m <br />0 <br />° If not, explain: i <br />A (�O <br />a <br />y <br />Application:A rove Denied Reason Denial: 1� 16 2017 <br />Gaf cv s/ � a�d OAlPA f4,) Re- rr711Q0 <br />Land Use: - Z3 zz, Ua%VRNZONING <br />r, <br />d <br />A <br />