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Fees (must accompany form): <br />Burnett County Subdivision Permit Application Subdivision Wo Survey: S50.00 <br />and/or Pre -Application Form Survey of Existing Parcel: $50.00/lot <br />PP <br />Subdivision w/ Survev: 5200.00+550.00/lot <br />`` <br />Owner:CpQCchCcidl _j` Buyer: <br />,o <br />Address:j`ILLAddress: <br />1 <br />B <br />a <br />Phone: �1! 5�%- 31,2 c? Phone: <br />lS-Sl�b�va5�� Orig inalParcelInformatio <br />!S- �t filo-�a� n <br />/S-y�_en.23c)pp <br />Parcel ID#: Q7 ©3S -yhly ?-S !-yf(6-o2y000 Section32Township lj/ Range <br />—� <br />-Z <br />Original Description (or attach copy): x'111 i..ty,-,tt.ci na P Me 5 ko �3 /' <br />Current Zoning: Floodplaita: I s;, Wetlands YAD Lak 'ver Class: <br />Name of Water Body: 1J 2S 0 nAL5 )-cyShoreland Agreement/SIPS <br />`� <br />Farmland Preservation YO Managed Forestry Law Y <br />New Parcel InfoV. <br />/rmation <br />Proposed New Legal Description and Parcel _ i(✓ p�_k1A <br />+rO -`Size: <br />Acres: <br />(if parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: <br />m <br />Proposed access to public waters to be provided Y/N: <br />If yes, describe access: <br />Signature of Owner: u ) <br />Date: / 6 :z� <br />Signature of Owner: Date: c <br />B <br />➢ Does parcel meet Zoning Requirements? Yes No .. <br />➢ Does parcel require a Survey? Yes No <br />d � <br />Permit application fees submitted? ❑ Amount ,S '049aReceipt # <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />BURNETr <br />