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Burnett County Subdivision Permit Application <br />and/or Pre -Application Form <br />Fees (must accompany form): <br />Subdivision tiv/o Survey: 550.00 <br />Survey of Existing Parcel: 550.004ot <br />Subdivision w/ Survey. 5200.00 + 550.00/lot <br />dwrv¢T ! <br />owner:.�utq.S 4,e;� , I�t�Sc�t� 1v�C', E A f, 'iceU <br />: -C I aA 65 2X0 6-,'" 1fuS t <br />.t.. <br />Address:_ 0 C-14 Address: it l ,� IZd E <br />ej� per' W -T cleO( <br />Phone: '7 S'tLl- i W q Phone: <br />original Parcel Information <br />07-0z3-a2-1Vv-14 2Y -S o.f ooy-o3l000 <br />Parcel Ila #: o S =Qoq - 0 i o I i> Sectionaq _TOWnshIP y() Rangel <br />Original Description (or attach copy): CS iru Pr3yS E K <br />Current Zoning:Z. � Floodpiait Yy : iYetlandsYl Vi ": L�� JR+ver Clam: <br />Name of Water Body: �f O'iCrLLZ-i e, L AF Shoreland Agreement/SIPS i til <br />Farmland Preservation Y 1 Managed Forestry Law Y6) <br />New Parcel Information <br />ProposedNewLegal Description and Parcel Size: Z)0W ' C 1& t f <br />2tceTir�ca <br />Acres: -3,30 <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, denfibe access: <br />Signature of Owner: � A � � Date: <br />Signature of owner Date <br />➢ Dees parcel meet Zoning Requirements? Yes No <br />Does parcel require a Survey? Yes i'a <br />D <br />as Permit a; ,plication fees submilleaf_' ❑ Amourt S � �, Receipt <br />t. <br />17 Reconedes with Real Property Lister Yes No Date: <br />0 <br />c If aot, explain. <br />n <br />n <br />0 <br />P <br />G <br />r® <br />Application: Approved l Denied Reason for Denial: <br />UCII^►uVlczo 17, <br />Land Uce: Date: <br />