Laserfiche WebLink
Burnett County Subdivision Permit Application <br />and/or Pre -Application Form <br />Owner. 9�M5 Eke^Drise5 Buyer: <br />1p/ <br />Address:75,?3 Nrn <br />_C;4, Address: <br />Phone: 91,L 6 S (, — ..-2� 0 Phone: <br />Fees (must accompany form): <br />Subdivision %v/o Survey: 550.00 `,- <br />Survey ofExistingParcel: S50.o0llot-K <br />Subdivision w/Survee $200.00+S5o.00,9ut <br />�� 032-�'��/b'a?&-y �s �o`f'a•�za Original Parcel Information <br />� <br />Parcel ID #: <br />I �- c�oY^ 031:1cpz' Section vZ Township yr Range &0 W <br />Original Description (or attach copy): 0t;' ; Inctk iow�,Si+e., J- <br />A <br />8ioA 3 <br />Current Zoning; C l Floodplain '//N Wetlands � <br />b Lake/River Class: <br />Name of Water Body: Shoreland Agreement/SIPS <br />R _ <br />Farmland Preservation tMlanaged Forestry Law <br />Information <br />New Parcel IR� <br />_ �/ z <br />Proposed New Legal Description and Parcel Size: /V . W 2 l o 4 5k—v\ <br />Acres: <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 />Signature of Owners` 4A,r ttiL l(��(retJ�%7%'%f✓ Date: <br />Y <br />Signature of Owner: Date: <br />D Does parcel meet Zoning Requirements? Yes No <br />➢ Does parcel require a Survey? <br />> Permit application fees submitted? ❑ <br />Yes No <br />Amount S /e2e, <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />c -/'e-#- /J^zi <br />.M <br />Receipt # <br />A plication: pproved / Denied /Reason fo D vial: <br />Land Use: Date:__ <br />O <br />a <br />R <br />.p <br />