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Fees (must accompany form): <br />Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br />Survey of Eisting Parcel: $50.00Flotand/or Pre -Application Form Subdivision <br />w/ Survev: 5200.00 + 550.00/lot <br />f t <br />Owner: _Mac- Buyer: <br />Address: l�cccin P �t Address:r�C', TP <br />LJ�- sY&'©1 <br />Phone: _60 c28'®- -.951/Phone: F <br />Cry <br />Orisinal. Parcel Information <br />Section 13 Township ` O Range <br />-�'� <br />Original Description (or attach copy): Lok P. ll'lt4_�,PyyZ i p �p<rck diUi tesv` <br />L.o-�s SIO+yI Elk 3 <br />9 <br />Current Zoning: h. I _ Floodplai Y i Wetlands Y : Lake( kiver Class: <br />I, <br />Name of Water Body: til ic�tLlP l81GK PAZiP- % r, K e Shoreland Agreement/SIPS V <br />� <br />9 <br />.. <br />Farmland Preservation Managed Forestry Law Yt <br />New Parcel Information r <br />Proposed New Legal Description and Parcel Size: Lo My 'rn.E <br />s <br />Acres: ®e q7 <br />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 />W <br />Signature of Owner: Date: <br />Signature of Owner: / 9 Date: do <br />> Does parcel meet Zoning Requirements? Yes No <br />e <br />➢ Does parcel require a Survey? Yes No <br />0° <br />r Permit application fees submitted? Amount $ Receipt Il <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />A <br />n <br />0 <br />w <br />Applicatio Approved L Denied Reason for Denial:... <br />Land Use: J z Date: <br />,._._ AUG 2 9 2017 <br />BURNETT COUNTY <br />Z 0 N I N G <br />