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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/ Survev: $200.00+$50.00/lot <br />Owner: ul+ _TeAnkle_ Q!�AN Buyer: tylmok'y— <br />ro <br />8 , <br />Address: o'�-� �[,t►'lSQ DY"' Address: _)a15O� (�c Co<�2-'4' AVL'. 0 4^ 30 � <br />ShQ�ce e MN 55, alvz <br />_Kkrnsv� 1�e, MN 353377 <br />Phone: C651oho- Phone: 95a — SS <br />Original ParcelInformation <br />Parcel ID#: <br />sy1-�3a-�-yl"Ifa^3lo-y o3-c:,6o-02Gc00 Section3(p Township qC Range _ <br />//n O <br />Original Description (or attach copy): W l/01 LA 5 Loi- int L c+ —7 d� <br />C51-1 \/ 9 P _N S1 A, <br />Current Zoning:IZ�D, Floodplain&: Wetlands YID— Lake/River Class: <br />Name of Water Body: G ut i L0.u_ Shoreland Agreement/SIPS Y/N: <br />Farmland Preservation I Managed Forestry Law/N: <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: <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 />y <br />Proposed access to public waters to be provide 1' <br />If yes, describe access: <br />Signature of Owner:"z�^--- Date: if- Xe- .,l <br />97 <br />Signature of Owner: L.1 Date: ' �3%l f n <br />0 <br />e <br />➢ Doesparcel meet Zoning Requirements? Yes No <br />R <br />�t <br />➢ Does parcel require a Survey? Yes No <br />D Permit application fees submitted? ❑ Amount $ Receipt # <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />Application: Approved / Denied Reason for Denial: <br />Land Use: Date: <br />