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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 Forin Subdivision w/ Survev: $200.00+$50.00/lot <br />Owner: �Y_ fY2 T f LCAN L' <br />Address:, /�7 1 2ru e. Z/71> <br />/k bbd A-1. .S 10 � <br />Phone: <br />Buyer: 44,V ,G/95 <br />Address: <br />ST- <br />506 <br />Phone: <br />Signature of Owner: 12.E Date: Z) �f <br />Signature of Owner: <br />Datc: <br />)o Does parcel meet Zoning Requirements? Yes No <br />➢ Does parcel require a Survey? Yes No <br />13 <br />I. <br />°Q ➢ Permit application fees submitted? ❑ Amount $ 7" r Receipt # <br />C.. ❑ Reconciles with Real Property Lister Yes No Date: r' <br />m <br />d <br />n If not, explain: <br />,'rJ — <br />m <br />0 <br />CL <br />y <br />A <br />Land <br />led Reason for Denial <br />Date: <br />ZO / <br />II <br />Orizinal Parcel Information <br />Parcel ID #: 27908 <br />Section-2-6Township 39 Range / 9 <br />Original Description (or attach copy): <br />f II/Z J' /=_ GJ - AJa q <br />d>° sc2 i 3 F� /;.) <br />bee. � , 7 y6 3Z "V a <br />/tease s�z <br />Current Zoning: 2_/2-3Floodplain Y/N: /V Wetlands Y/N: /y Lake/River Class: <br />Name of Water Body: <br />Shoreland Agreement/SIPS Y/N: <br />Farmland Preservation Y/N: <br />Managed Forestry Law Y/N: n/° <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: _ z <br />it 5ee G7 %%6tc.`(�' ,t Ai7� <br />// G <br />~ — ��C Cr'� �i /t��G/it10 /r, <br />Z-41U_�5 7y,9f fQ2)fifD <br />-71� IqPf ,eAJi2 Acres: e. ei gcIzio3 <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: �x'ISter <br />N4 'Ar" tueS -to ),>-Z *�1 .SD /J ),>-b <br />Proposed access to public waters to be <br />provided YIN: <br />If yes, describe access: <br />Signature of Owner: 12.E Date: Z) �f <br />Signature of Owner: <br />Datc: <br />)o Does parcel meet Zoning Requirements? Yes No <br />➢ Does parcel require a Survey? Yes No <br />13 <br />I. <br />°Q ➢ Permit application fees submitted? ❑ Amount $ 7" r Receipt # <br />C.. ❑ Reconciles with Real Property Lister Yes No Date: r' <br />m <br />d <br />n If not, explain: <br />,'rJ — <br />m <br />0 <br />CL <br />y <br />A <br />Land <br />led Reason for Denial <br />Date: <br />ZO / <br />II <br />