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Fees (must accompany form): <br />Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br />Survey of Existing Parcel: $50.004ot <br />and/or Pre -Application Form Subdivision w/ Survev: S200.00+$50.00/lot <br />Owner: S► ac 'e� 1-4 !✓ \ Buyer: .9 <br />Address:; A (- LAu 5 ll f. Address: 3 <br />Phone: Phone: <br />Original Parcel Information <br />07 o3Fsvz 5- /S- q�-(<- I AC—) <br />Parcel ID#: Section 3,) Township V/ Range <br />P <br />rr O <br />Original Description (or attach copy): M uk-OLLL i tim D; At? `, 4ol 1 o(a I /0,5-4- 107 0 <br />_ <br />V 1 <br />Current Zoning:_Floodplait'Y N: Wetlands a e/River Class: r <br />Name of Water Body: �o�tk � !?� Shoreland Agreement/SIPS lq/ - (� <br />Farmland Preservation VIN:,, Managed Forestry Law /N: <br />New Parcel Information( �� 7 <br />Proposed New Legal Description and Parcel Size:C. 5Wt <br />Acres: -3. 3 (a <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: z. 22 i , -FZ <br />d <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 No <br />Date: 9116,01,.4 <br />Date: <br />Does parcel require a Survey? Yes No <br />Permit application fees submitted? Amount $ Receipt <br />❑ Reconciles with Real Property Lister 111 Yes No Date: <br />If not, explain: <br />Application: Approved <br />Denied Reason for Denial: <br />Land Use: 2 < ' - <br />;17 Date: <br />v <br />