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Fees (must accompany form): <br />Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br />Acres: 2 L . 0 <br />Survey of Existing Parcel: $50.00/lot <br />and/or Pre -Application Form Subdivision Survev: 5200.00+S50.0011ot <br />(If parcel is to be surveyed, provide preliminary map. See attached <br />for preliminary map requirements.) <br />w/ <br />Proposed access to public road: <br />Owner: I V I S �e_� P Y -5C> > 1 Buyer: <br />IV <br />Address: 2- 3 e CSOt'1 Address: <br />A <br />3 <br />m <br />�4g-72- <br />z <br />0 <br />L I S <br />� <br />Phone: Phone: <br />p <br />If yes, describe access: <br />Original Parcel Information <br />�J <br />Signature of Owner: � <br />Date:1v? <br />Parcel ID #: 07 L ' 38 -F)-6-1 o3wcc ctla*ection__a_Townshie 3E Range_LU1 <br />Signature of Owner: <br />� <br />c <br />r <br />Original Description (or attach copy): S W IVE ar\A SE Mt- (WY- V OU <br />O <br />> Does parcel meet Zoning Requirements? Yes <br />No n n� (� <br />lie c `� f//l % Jul /i7� <br />Does parcel require a Survey? Yes <br />No <br />o <br />00 <br />Permit application fees submitted? ❑ Amount S <br />�,p <br />Z✓�0 ' Receipt 9 <br />Current Zoning: A2 Floodplain Y/N:__1e,LWetlands Y/N: Ye Lake/River Class: <br />❑ Reconciles with Real Property Lister Yes No <br />(^ <br />m <br />°' <br />If not, explain: <br />70 <br />A <br />n <br />Name of Water Body: Shoreland Agreement/SIPS Y/N: <br />0 <br />a <br />Farmland Preservation Y/N: IA Managed Forestry Law Y/N: tit a <br />New Parcel Information <br />0 <br />0 <br />Land Use: « I'lel <br />Proposed New Legal Description and Parcel Size: ►1�'_' V3 1 10LSA, <br />"T <br />Acres: 2 L . 0 <br />(If parcel is to be surveyed, provide preliminary map. See attached <br />for preliminary map requirements.) <br />Proposed access to public road: <br />0 <br />m <br />Proposed access to public waters to be provided Y/N: <br />A <br />ti <br />If yes, describe access: <br />�J <br />Signature of Owner: � <br />Date:1v? <br />Signature of Owner: <br />Date: <br />c <br />3 <br />> Does parcel meet Zoning Requirements? Yes <br />No n n� (� <br />lie c `� f//l % Jul /i7� <br />Does parcel require a Survey? Yes <br />No <br />o <br />00 <br />Permit application fees submitted? ❑ Amount S <br />�,p <br />Z✓�0 ' Receipt 9 <br />�. <br />❑ Reconciles with Real Property Lister Yes No <br />Date: <br />m <br />°' <br />If not, explain: <br />70 <br />A <br />n <br />0 <br />a <br />Applicata Approved / nied Reason for Denial: <br />Land Use: « I'lel <br />Date: <br />