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Burnett County Subdivision Permit Application <br />and/or Pre -Application Form <br />Owner:'bctt„1 4 116LI o9 -ee (ii fc-i'is Buyer: <br />Address: '10 33 'beck 4,.ke Address: <br />Phone: <br />Phone: <br />Oriainal Parcel Information <br />g l 4 LO <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 + S50.00/lot <br />V5 o03_UlliV0 Section � Township 91 Range /S <br />Original Description (or attach copy): 421-,? <br />C /_ 6-0" /-" � -? (/-a <br />iRR3 <br />Current Zonin ��'Z <br />g: F a Floodplain Y/N: Wetlands Y/N: (Lak�iver Class: <br />F— <br />Name of Water Body: U 0'e ( CL�k e-, Shoreland Agreement/SIPS YEN: ) <br />R <br />Farmland Preservation V( ) Managed Forestry Law Y(N:_, <br />New Parcel Information VeJJ42 r, I�����(0 <br />Proposed New Legal Description and Parcel Size: • ' � <br />Land Use <br />ZD/ % <br />BURNETT" COUNTY <br />Z?C, NING <br />10. <br />tt. <br />Acres: [n. ReD <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 />Signature of Owne • _ <br />Date: ! <br />Signature of Owner: <br />Date: 3- j7 - <br />7 -Does <br />Does parcel meet Zoning Requirements? Yes <br />ivo <br />> Does parcel require a Survey? Yes <br />No <br />o' <br />Q0 <br />r Permit application fees submitted? Amount $ <br />I 1DO , C) <br />Lr Receipt # <br />�. <br />❑ Reconciles with Real Property Lister Yes No <br />Date: <br />m <br />0 <br />If not, explain: <br />n <br />0 <br />a <br />Application: pprovedJ Denied Reason for Denial: <br />In I RM I Ir± <br />Land Use <br />ZD/ % <br />BURNETT" COUNTY <br />Z?C, NING <br />10. <br />tt. <br />