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Ox <br />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 Subdivision w/Survey: $200.00+$50.00/lot <br />A� Vv S kxQge_ LLL <br />Owner: ACME_ "are_ 11421eT Bony Buyer: <br />Address: Zy 250 13; q Sand LA kf- ar Address: <br />W� <br />Phone: 0-15 1 Phone: <br />Oriainal Parcel Information <br />o7-o2ip-2-39-15-32-5 05-008- ®25010 <br />Parcel lD #: 0 1 0 -MP 2-f� , 1 5 -3Z -s 05- WS - 02-4 "§'ection 3 2 Township 3y Range_ <br />Original Description (or attach copy): LLA--, Z + 3 &� UM V <br />(GQ y 1 -oi Yi) <br />Current Zoning: R?, I Floodplain YQ—Wetlands Y/ 'c Lake/River Class: <br />Name of Nater Body: — Shoreland Agreement/SIPS YIN: <br />Farmland Preservation Y/e-,�) Managed Forestry Law Y/ <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: LLL ce-(J kltj S-krVZ <br />cn,Mb`► ru _ l ods 2 3 CSN V 20I - ), <br />Acres: L1, 31 <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 YIN: <br />If yes, describe access: <br />Signature of Owner: �4— - Date: i ?� <br />Signature of Owner: <br />Date: <br />> Does parcel meet Zoning Requirements? Y'es Ivo <br />> Does parcel require a Survey? Yes No &A---��� Z"J <br />Permit application fees submitted? ❑ Amount $ sa Receipt 9 <br />�. ❑ Reconciles with Real Property Lister Yes No Date: <br />y <br />If not, explain: <br />M <br />m <br />n <br />0 <br />z <br />G <br />Applicatioc. (Approved /!Denied Reason for Denial: <br />Land <br />X <br />Date: <br />10 <br />PX - <br />GA <br />Co75 <br />4r <br />C <br />d <br />