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., <br />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+$50.00/lot <br />1I p (� Pe YX 1_U0 <br />,,✓II\ <br />Address: t-,2 7q75- �-� RA Address: 2 ':� qL3 z <br />�v �« <br />Phone: Phone: -7&3- a Lia , / y C c( <br />Original Parcel Information <br />Parcel ID #: o5 -coq 1 t nruc Section--Y—Township L/O Range <br />Original Description (or attach copy): csv 40 / 5 — S&-, 3t 7 <br />`it � <br />l <br />Current Zoning: Floodplain _Wetlands /N: Lake Iver Class: <br />Name of Water Body: .—FIS h L"k e-. Shoreland Agreement/SIPS YfF� <br />Farmland Preservation Y <br />Managed Forestry Law Y 15• <br />New Parcel Information I <br />Proposed New Legal Description and Parcel Size: A e �-J � /c7 T <br />Acres: <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: <br />Proposed access to public waters to be provided YIN: <br />If yes, describe access: <br />Signature of Owner: <br />Date: <br />Signature of Owner: <br />Date: <br />> Does parcel meet Zoning Requirements? Yes <br />No <br />Ru 12/y / -7 Q� <br />> Does parcel require a Survey? Yes <br />No <br />0° <br />r Permit application fees submitted? ❑ Amount <br />$ pD. <br />Receipt k <br />t.. <br />❑ Reconciles with Real Property Lister Yes No <br />Date: <br />d <br />0 <br />0. <br />If not, explain: <br />x+ <br />A <br />n <br />0 <br />ffo-r Denial: <br />ApplicatioIE;e�d�lDenied <br />/Reaso <br />9 unit T� l�t'a'►'1V117 if4y <br />dla <br />Land Use:V45n—.-1 7 <br />Date: <br />