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Burnett County Subdivision Permit Application <br />and/or Pre -Application Form <br />NJ, i4 o t s+ I-'- -- <br />Owner: ftleCr'i 5 401-5f Buver: <br />Address: f5 f a 138-1" 5J. Address: <br />Phone: _7/5' 21'al I,SO Phone: <br />Orieinal Parcel Information <br />A-;3`-' <br />Fees (must accompany form): <br />Subdivision w/o Survey: $50.00 <br />Survey of Existing Parcel: S50.00/lot <br />Subdivision w/ Survev: 5200.00 + $50.00/1ot <br />ParcelSection 7 Township 38- Range 1,5— <br />Original <br />SOriginal Description (or attach copy): f 3 <br />Current Zoning:_ Floodplain YQNL_Wetlands V&,—'/—Lake/River Class: <br />Name of Water Body: Shoreland Agreement/SIPS V <br />Farmland Preservation Y6: , Managed Forestry Law 1K <br />New Parcel Information / <br />Proposed New Legal Description and Parcel Size: _� %n V e %2 P Is <br />Q /- ( O <br />F <br />s. <br />0 <br />A <br />C:) <br />Vl <br />Acres: <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: C <br />Proposed access to public waters to be provided Y/N: <br />.1 <br />If yes, describe access: <br />Signature of Owner: 9,Date: <br />Signature of Owner: Date: e <br />B <br />> Does parcel meet Zoning Requirements? Yes No ° <br />A <br />3t <br />> Does parcel require a Survey? Yes No <br />I/ <br />Permit application fees submitted? Amount $-3 r Receipt 9 <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />Applica <br />Land <br />Approved denied Reason for Denial: <br />Date: Bi113N;:lt\ITV <br />ZOi ING <br />