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Burnett County Subdivision Permit Application <br />and/or Pre -Application Form <br />Owner: SEL_CtPct't�y Slrn Buyer: <br />Address: tR&a 6' 6fe - 3e.f C+ Address: <br />tea �l, L.J-T S�F'3o <br />Phone: _715- ?33'o`�a3 Phone: <br />Fees (must accompany form): <br />Subdivision w/o Survey: $50.00 <br />Survey of Existing ParcelC�foi� <br />Subdivision w/ Survev: S200.00 + 50.00Ao( <br />Original Parcel information <br />ParcellQ#:o�b(a-�?-yn-/5-1�5 1dSSo<3(op00o Section /3 Township 4/0 Range 1S <br />Original a.` IJP Description (or attach copy): Gre4, A6A -6 ( joyct e i (Ji !I a.a �e_ <br />--Le) +'.5 ; .5 oo., A c2 (n <br />Current Zoning: _Floodplain V(Y.�Wetlands Y N:,) LakefRiver Class: <br />Name of Water Body: Shoreland Agreement/SIPS YM_ <br />Farmland Preservation V, Managed Forestry Law YjR <br />New Parcel Information �/ %9�2 1", 135— <br />Proposed New Legal Description and Parcel Size: A)eLy c6 m <br />lu 9 01o7s I CNI_ 1� <br />Acres: I o 0 (r, <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 />X Signature of Owner: <br />X Signature of Owner <br />➢ Does parcel meet Zoning Requiremenls? <br />➢ Does parcel require a Survey? <br />> Permit application fees submitted? <br />Date: g 7 <br />Date: //e/// 7 <br />Yes No <br />Yes No <br />Amount $ — Receipt li <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, <br />Application:/�ApproveA-,(Denied Reason for <br />Land Use: <br />BURNETT COUNTY <br />ZONING <br />