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Fees (must accompany form): <br />Burnett County Subdivision Permit Application Subdivision Wo Survey; $50.00 <br />Surveyof Existing 0.0 <br />and/or Pre -Application Form Subdivision w/Sureev: S200.00+$50.00/lot <br />0 W r1t'r, <br />Owner: C 110. A .Lmme- 4uyei=: jnV) n Ljid {NAnre, are+ o y)rn] <br />Address:.519 9 3�ale_ 'RA -7(.) Address: U9 <br />liJ z�5i e r fir,! 1 St-{ 3 S�.-P,,.,t i <br />Phone: 7157 — 502 — (,72 7 Phone: <br />Orieiinal Parcel Information <br />07-CQ4 2-39-i5-32-5 05 oata r35aCC <br />Parcel ID #-- 07 •CZ(a-2-,39- F5 3z-5 �S ccs'- OU, 0V0 Sertion32Townshie 39 Range <br />Original Description (or attach copy): L4 ! o� CSM \i Z alu 5 �z 3 1c)0, narce_I o� <br />Current Zoning: z I / Floodplain Y/N:�Wetlands Y/N: <br />a Name of Water Body: \I iyjA 1_ ch Shoreland Agreement/SIPS Y/N: <br />.. Farmland Preservation Y/'V b'lanaged Forestry Law I /N: <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size:LoV <br />Acres: <br />(If parcel is to he surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Pre pu tc road: -- <br />Proposed access to public waters to be provided WIN: <br />If yes, describe access: <br />Signature of Owner: Date: <br />Signature of Owner: Date: <br />> Does parcel meet Zoning Requirements? Yes NO <br />> Does parcel require a Survey? <br />Yes No <br />Permit application fees submitted? ❑ Amount S <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />Applicati : Approved <br />Land Use: <br />Reason for Denia <br />Date: <br />Receipt 9 <br />s� <br />4 <br />