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Owner: a�C �- Y I �(� Buyer: <br />� <br />Address:'- %k.L Address: <br />Phone: / ` /! l Phone: 0 <br />Original Parcel Information <br />�7--0�0 �a .. <br />Parcel ID #: C»'� f 000--016000 Section C Township Range_ <br />Original Description (or attach copy): r <br />A' <br />1" <br />4, <br />Current Zoning: Floodplain Y/N:__h�_Wetlands Y/N:_Lake/River Class: <br />> Name of Water Body: Shoreland Agreement/SIPS Y/N: / <br />M <br />' Farmland Preservation Y/N: Managed Forestry Law Y/N: <br />0 <br />New Parcel Information <br />u,. <br />Proposed New Legal Description and Parcel Size: ��� Il a C <br />d <br />a� <br />Acres: 0, fD <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 />b <br />If yes, describe access: z <br />Signature of Owner: Date: TT <br />Signature of Owner: Date: <br />➢ Does parcel meet Zoning Requirements? Yes No <br />c ➢ Does parcel require a Survey? Yes No <br />aro i Permit application fees submitted? ❑ Amount $ Receipt # <br />❑ Reconciles with Real Property Lister Yes No Date: 71 <br />r <br />If not, explain:L6 U L6 11 UT <br />a <br />° Application ' Approved / _Denied Reason for Denial: <br />Land Use - <br />Date: B`yRNET ' COUNTY <br />ZONING <br />Fees (must accompany form): <br />Burnett County Subdivision Permit Application <br />Subdivision w/o Survey: $50.00 <br />and/or Pre -Application Form or Map Review Form <br />Survey of Existing Parcel: $50.00/lot <br />Subdivision w/ Survev: S200.00 + S50.00/lot <br />Owner: a�C �- Y I �(� Buyer: <br />� <br />Address:'- %k.L Address: <br />Phone: / ` /! l Phone: 0 <br />Original Parcel Information <br />�7--0�0 �a .. <br />Parcel ID #: C»'� f 000--016000 Section C Township Range_ <br />Original Description (or attach copy): r <br />A' <br />1" <br />4, <br />Current Zoning: Floodplain Y/N:__h�_Wetlands Y/N:_Lake/River Class: <br />> Name of Water Body: Shoreland Agreement/SIPS Y/N: / <br />M <br />' Farmland Preservation Y/N: Managed Forestry Law Y/N: <br />0 <br />New Parcel Information <br />u,. <br />Proposed New Legal Description and Parcel Size: ��� Il a C <br />d <br />a� <br />Acres: 0, fD <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 />b <br />If yes, describe access: z <br />Signature of Owner: Date: TT <br />Signature of Owner: Date: <br />➢ Does parcel meet Zoning Requirements? Yes No <br />c ➢ Does parcel require a Survey? Yes No <br />aro i Permit application fees submitted? ❑ Amount $ Receipt # <br />❑ Reconciles with Real Property Lister Yes No Date: 71 <br />r <br />If not, explain:L6 U L6 11 UT <br />a <br />° Application ' Approved / _Denied Reason for Denial: <br />Land Use - <br />Date: B`yRNET ' COUNTY <br />ZONING <br />