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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 Subdivisionvv/Survev: $200:00+$50.00/lot <br />Owner: &M,y Bonckc_ Buyer: <br />Address: Sq 3A C�QkkcL,.4n Ave— Address: <br />MN 55,4ay <br />Phone: k `tD tL ) (V 5 A - I ! 1'LV Phone: <br />Original Parcel Information <br />Parcel ID #: 07_C3 a�-r?- 4 I - Itv- 3(y -S-dl��^cecy Section f3� tt Townshi� Range <br />Original Description (or attach copy): Pc,L L -- 1 o V <br />Current Zonina: Floodplai Y t Wetlands Ye Lake/River Class: <br />Name of `Vater Body: M ! eAn n re. "P_ Shoreland Agreement/SIPS Y/N: <br />Farmland Preservation %I- <br />New <br />Managed Forestry Law I <br />Parcel Information I L{�� <br />Proposed New Legal Description and Parcel Size: � .ta \ I Lc�� C c:l A <br />0 <br />Acres 3, <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: <br />G <br />Proposed access to public waters to be provided Y/N: <br />J <br />If yes, describe access: <br />W <br />i <br />07/20/2018 <br />S� <br />t�� <br />Signature of Owner:Amu s:ui,'o ; Date: 06:15 PM CDT <br />p <br />Signature of Owner: Date: <br />o <br />'c <br />z <br />➢ Does parcel meet Zoning Requirements? Yes No L c, 7 4_7 I <br />L <br />➢ Does parcel require a Survey? Yes No <br />`a Permit application fees submitted? ❑ Amount $ Receipt # <br />r, <br />❑ Reconciles with Real Property Lister Yes No Date: <br />c <br />If not, explain: <br />r <br />0 <br />c <br />Application: Approved / enied Reason for Denial: <br />Land Use: 3� Date: <br />