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Burnett -County Subdivision Permit Application <br />and/or Pre -Application Form <br />Pe c Cm to t Pqrese— <br />Fees (roust accompany forni): <br />Subdivision w/o Survey: $50,00 <br />Survey of Existing Parcel; $50.00/lot <br />Subdivision w/ Survcv: 5200,00+S50,00/lot <br />Address: a0.5-66 b ak 276 6r.8 Lk Tri I Address: ofaS7,5- A'reh L61,2rA J-k',rr-I <br />Phone; Phone: <br />l c 6 T/ W _r Sy830 <br />_00s - <br />Or' <br />D©,S <br />o7-o�Fsa-yo/'I1�,5 Or'ieinalParcelInformation <br />o,S-, i07 -0t Y000 <br />Pareel lD#: ts�07-0 rxoo <br />0.5 =��7- cs i 000 Section j � Township q Range <br />Original Description (or attach copy): (6M 4, G 3& V 1 1 P1 7, <br />Ti, 6-&0 L f 7 b e i�� a t �- d i' D a �c� f -7 S o �' <br />Currant Zoning:Floodpla/Y !: Wetlan Y/ Lake River Class: <br />Name of Water Body: i rry, `1= s %ae.ri Shoreland Agreement/SIPS Y&— <br />Farmland <br />N'Farmland Preservation <br />d Forestry Law <br />New Parcel Information V <br />Proposed New Legal Description and Parcel Size: A) e L'i C� 16+ C cS YY\ <br />Acres: qa P <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 Ow er: <br />(� <br />".rix Date: 9 '/% <br />Signature of Owner: <br />Date: <br />Does parcel meet Zoning Requirements? <br />Yes <br />No <br />Does parcel require a Survey? <br />Yes <br />No <br />Permit application fees submitted? ❑ <br />Amount S (�t9' Receipt # <br />v <br />❑ Reconciles with Real Property Lister <br />Yes <br />No Date; <br />0 <br />If not, explain: <br />R <br />0 <br />Applicati Approved/ D ied Reason for Denial:. <br />_ <br />Land Use. - <br />ZO/ Date: <br />