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Fees (must accompany form): <br />Burnett County Subdivision Permit Application Subdivision vv/o Survey: $50.00 <br />Survey of Existing Parcel: $50.00/lot <br />and/or Pre -Application Form Subdivision w/Survey: $200.00+$50.00/lot <br />Owner: PA V 1 y Ries Buyer: <br />Address: 2 7 $.3 6 'If/ 1-0 I -#A' lav . Address: <br />wtj Ir^ Wts 54843 <br />Phone: &51. 78?- SZ 1-7 Phone: <br />Original Parcel Information <br />15I- , — 04S000 - 600C)o ! <br />Parcel ID #: 07.OS1.1.4111P-28 'S' Section 2c7p Township 9 ( Range' h <br />Original Description (or attach copy): Lo i I - C /,S / Z. f r 4* go. -hi h/� <br />401d'11 *Aq 4• Doteuoq k 13) <br />756o ctp%y... <br />Current Zoning: QR Floodplain Y & <br />_Wetlands 1 / Lake/River Class: <br />Name of `Vater Body: Shoreland Agreement/SIPS Y/N: <br />Farmland Preservation Y/N: <br />Nlanaged Forestry Law Y/N: <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: Z L o d C_ S/Zl <br />Acres: <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: 61 fil Ott, <br />d <br />Proposed access to public waters to be provided Y/N: <br />D. <br />If yes, describe access: W <br />0 <br />t <br />Signature of Owner: `�� Date: <br />00 <br />Signature of Owner: Date: o <br />c <br />> Does parcel meet Zoning Requirements? Yes 1V0 Grp h� /8'677 <br />z <br />N �t <br />Does parcel require a Survey? Yes No <br />Q° > Permit application fees submitted? ❑ Amount S l0V Receipt # <br />�. ❑ Reconciles with Real Property Lister Yes No Date: <br />c <br />If not, explain: <br />n <br />0 <br />c <br />Applicatio pproved Denied Reason for Denial: <br />Land Use:_ <br />