Laserfiche WebLink
Burnett County Subdivision Permit Application <br />and/or Pre -Application Form <br />Owner: ✓�C�il(,�Q� C�Gt4`GC �) - Buyer: <br />Address: Lry L X <br />Address: <br />d14 <br />Phone: �08) 62481-1)361 <br />Phone: <br />Original Parcel Information <br />Fees (must accompany form): <br />Subdivision w/o Survey: $50.00 <br />Survey of Existing Parcel: $50.00/lot <br />Subdivision w/ Survev: $200.00 + S50.00/lot <br />Parcel ID #: ((; -Ui dJ <br />p - - y;lCZr✓ <br />Section��Township `� � <br />Range <br />Original Description (or attach copy): <br />A% E - A) <br />E <br />Current Zoning: Floodplain Y/N: iy Wetlands Y/N:_Lake/River Class: <br />Name of Water Body: <br />Farmland Preservation Y/N: <br />Shoreland Agreement/SIPS Y/N: <br />Managed Forestry Law Y/N: �>2' 4 c�-O &� K l <br />New Parcel Information <br />Q <br />Proposed New Legal Description and Parcel Size: 5e e �`l �(a c <br />A5 1- 4 <br />Acres: 6;2 , '-3 6 <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: L U, L� �6 { tiVwS (ac(e $ e. i L <br />Proposed access to public waters to be provided Y/N: <br />If yes, describe access: <br />Signature of Owner: <br />Signature of Owner: <br />i, r <J � e o . Date: <br />Date: <br />-(/1 <br />➢ Does parcel meet Zoning Requirements? Yes No / <br />)0, Does parcel require a Survey? Yes No <br />om <br />� Permit application fees submitted? ❑ Amount $ Wc_�i Receipt # <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, <br />Applicatio Approved / enied Reason for Denial: <br />Land Use: <br />Date: <br />C/) <br />d <br />w <br />W <br />