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fees (must accompany form): <br />Burnett County Subdivision Permit Application Subdivision w/oSurvcy: 550.00 <br />and/or Pre -Application Form SurvcyofExisting Parccl:: $50.00/lot <br />PP Subdivision <br />w/ Survev: S200.00 + S50.00/lot <br />IJ, <br />Owner: LIgOA HC -991c -k Buyer: <br />Address: Zqb q 2 e? y R D AV Address: <br />i,/ 6 h Pf- <br />R <br />Phone: Phone: <br />Orieinal Parcel Information <br />�. <br />07-0o(o-ol-3fs-t7-iv-3 vy-�p_olloc��� <br />Section <br />n�ownshh- 3� Range /7 <br />Parcel IDj\ <br />Original Description (or attach copy): St-Slv T� d <br />O <br />1 <br />('e n /'Y /il E 'S <br />Current Zoning: _ A Floodplain Y&1 Wetlands Y& Lake/River Class: <br />R <br />Name of Water Body: Shoreland Agreement/SIPS Y/N: <br />Farmland Preservation Managed Forestry Law Y/N: <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size:. et -o- .3 to 7- S yYl <br />Acres: '7 j„ /j <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: e <br />^� <br />m <br />Proposed access to public waters to be provided Y� <br />GO <br />If yes, describe access: <br />�p <br />Signature of Owner: 4Date: <br />Signature of Owner: Date: <br />n <br />0 <br />3 <br />> Doesparcel meet Zoning Requirements? Yes No <br />N <br />o <br />o <br />5' <br />> Does l require a Survey? <br />P arce9 Y? Yes No <br />n <br />� <br />Q° <br />Permit application fees submitted? Amount $fie (,�� Receipt 9 <br />❑ Reconciles with Real Property Lister Yes No Date: <br />0 <br />7v <br />If not, explain: <br />n <br />0 <br />a <br />H <br />Applicatio Approved enied Reason for Denial: <br />JULZ8 7017 <br />Land Use: 7 Date: <br />mss, °I ZONING <br />