Laserfiche WebLink
n <br />Fees (must accompany form): <br />Burnett County Subdivision Permit Application SubdivisionwloSurve'y: 554.00 <br />Sunny of Existing Parcel: S50.Motl-k <br />and/or Pre -Application Form Subdivision w/ Survey: S200.00+$50.00,lut <br />(4 <br />Owner: 19 (ca, #0t1etf'6YK_5 4Je:pti-se5 Buyer: ,e <br />!r{ e a!/ <br />LJ 4S <br />u5 / <br />Zo/7. rx' ✓��jr <br />Address: <br />Phone: <br />Original Parcel Information <br />1 <br />Section $ Township Range / (_0 W <br />Dt i 2 inch 7OWytiSi 1't'. c9 4. cLy"�ULA � <br />L/ <br />t! _Wetlands Y/N' _lake/River <br />Shoreland Agreement/SIPS YIN ) <br />Managed Forestry Law <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: /(/ P. Inc) 2 l o 4 C S k),A <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 YIN: <br />If yes, describe access:,, <br />Signature of <br />Signature of Owner: <br />D Does parcel meet Zoning Requirements? <br />> Does parcel require a Survey? <br />Permit application fees submitted? ❑ <br />Date: <br />Date: <br />Yes No <br />Yes 11'0 �- <br />Amount S 1411�1e' <br />=LI <br />Receipt 9 <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />App stion: Approv / Denied Reaassyo�n for Denial: <br />ti <br />Land Use: n/ .t_. lr pdi r.o 2 <br />rA <br />O <br />zi <br />ro <br />SeE <br />MA 1 <br />