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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: $50.00/lot <br />and/or Pre -Application Form Subdivision w/ Survev: $200.00 + $50.00/lot <br />Owner: D(1 V 11J R1 Q Buyer: <br />Address: r lit y7 EmEi2/ r1 VE E Address: <br />X 67-/W6 �'ie 5, 033 <br />Phone: <br />Phone: <br />785y eoko " OriQinalParcel Information / ,-/ <br />Parcel ID #: 032- 532 9- Qa oo Section � Township '1'11V Range 16 W <br />Original Description (or attach copy): J5 a6 kO5 Al E 5C <br />Current Zoning: Floodplain Y& Wetlands Y& <br />Lake/River Classification: Name of Water Body: <br />Shoreland Agreemt or SIPS Y,_T• Farmland Preservation Y&O Managed Forestry Law Y&__ <br />New Parcel Informatio�n <br />Proposed New Legal Description and Parcel Size: <br />Acres: /0 a <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: Co lecl r <br />Proposed access to public waters to be provided Y . <br />If Yes, describe access: <br />c Signature of Owner Date: <br />Signature of Owner: Date: <br />➢ Does parcel meet Zoning Requirements? Yes No <br />➢ Does parcel require a Survey? Yes No <br />a m� <br />Permit application fees submitted? 0 Amount $ . Receipt # <br />0 <br />a <br />0 Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />nn <br />it <br />Applicatio Approved_1 Denied Reason for Denial:___ EP 7 ?�17 <br />Land Use:Z7, Date: — ac <br />W <br />