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M <br />Fees (must accompany form): <br />Burnett County Subdivision Permit Application Subdivision ,v/o Survey: $50.00 <br />Survey of Existing Parcel: $50.00/lot <br />and/or Pre -Application Form Subdivision w/ Survev: $200.00+$50.00/lot <br />Owner: Po-�r;dq S►ti- o!n <br />Address: —%I I ei (p(D*'% S4 <br />Buyer: &U4 •,e1- :TaSk Pa"i"nfFd <br />Address: i3in H0. deY1 L44 -C <br />MN 5509 <br />Phone: N50 4(p. -Z- yla9 (p Phone: <br />Original Parcel Information <br />ParcelID#: e7•o3Z-2-4(-1!0• 1.1 0l•000•011oo1Section 29 Township L41 Range 142 <br />Original Description (or attach copy): NENEX Pirtn S cP \&N -]%� <br />Current Zoning: RR3 Floodplain Y&—Wetlands Y(8'_Lake/River Class <br />Name of Nater Body: VX 4 Shoreland Agreement/SIPS Y <br />Farmland Preservation Y,S Managed Forestry Law Y <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: 2 Lo fii <br />l 4 2-CAc / <br />Acres: 6; , f>U <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: et!a t <br />Proposed access to public waters to be provided,S� <br />If yes, describe access: e — <br />Signature of <br />Date: s h3 11$ <br />Signature of Owner: Date: <br />t� <br />> Does parcel meet Zoning Requirements? Yes No f, 2� � 7-)l <br />R <br />3 (J 67.Cle <br />> Does parcel require a Sauey? Yes No <br />v <br />Q° Permit application fees submitted? ❑ Amount $ �j^ Receipt'# <br />�.. ❑ Reconciles with Real Property Lister Yes No Date: <br />a <br />If not, explain: <br />n <br />n <br />0 <br />c <br />Applicatio • Appro—Vee/ Denied Reason for Denial: <br />Land Use: <br />