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Burnett County Subdivision Permit Application <br />and/or Pre -Application Form <br />Fees (must accompany for ): <br />Subdivision w/o Survey: $50.00 <br />Survey of Existing Parcel: S50.00/lot <br />Subdivision .v/ Survcv: S200.00 + S50.00/lot <br />Owner: Greg ,4,A cson 0ryvas _1� rn <br />Address: a 82(o� lJ }y e iyt R C • Address: _cR &L V v WJ el r\ ZA <br />oelzk w -T LJ e,64ex, 60y <br />Phone: L la- 75-0- 030 Phone: 5o7-S33"�via(o7 <br />OriP_inal Parcel Information <br />v7oag-�-ao-IN-I`r-s os=ooa-oi3ool <br />Parcel ID #: 05--001- v 11001 Section jq Township Li(_? Range <br />Original Description (or attach copy): �64S dw-3 CS rA V c( pr� '? a L—� X P, <br />(i Lo� q CspyA vel P3aI� °l' P( -t 1df 3 <br />(_ SYh VC? Pa &ai)esc '56-3b71 f l (Croy 1.0 �- lg� <br />�FloodplainSY:urrent Zoning:dClass: <br />•o r, <br />Name of Water Body: T_ S1C"d j -ax e_ Shoreland Agreement/SIPS Y N• <br />R Farmland Preservation Y�I Managed Forestry Law Y <br />New Parcel Information rr /� <br />Proposed New Legal Description and Parcel Size: _ V e ui � 4 6 T Cs m v 'I- <br />-2�c.�.c <br />Acres: <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: _a'�X � S 4 I ,gym <br />Proposed access to public waters to be provided Y/N: <br />If yes, describe access: <br />C.� <br />v <br />A <br />R.> <br />Signature of Owner: <br />Date: <br />Signature of Owner: Zi <br />Date: <br />> Does parcel meet Zoning Requirements? Yes <br />No <br />> Does parcel require a Survey? Yes <br />No <br />5' <br />0° <br />s Permit application fees submitted? ❑ Amount $ <br />(190, <br />Receipt 9 <br />t.. <br />❑ Reconciles with Real Property Lister Yes No <br />Date: <br />0 <br />°• <br />If not, explain: <br />A <br />n <br />0 <br />a <br />H <br />Applicationpprove Denied Reason for Denial:._ <br />Land Use: 0/z" <br />Date: <br />C.� <br />v <br />A <br />R.> <br />