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Fees' <br /> mus <br /> t accompany torm): <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+$50.00/lot <br /> / so yt� r /� <br /> Owner: �/C � 11511PNsgP� r t-�lJ Buyer: STFV E-81� /V <br /> Address: o7SS�3 — S �d• i� Address: 3 <br /> w'EBSf�K k!j <br /> Phone: ( 7/5 - �� Phone: �}J <br /> Original Parcel Information Mee"At- <br /> Parcel ID#: 0 I g-332)- DI -M D Section Township ,�39 Range <br /> /^ LO_ 1 O <br /> Pt <br /> Original Description(or attach copy): +- iz <br /> o <br /> e Current Zoning: l—� R2' _ Floodplain Y/N: A) <br /> Current Wetlands Y/N: t <br /> _ 0'7 <br /> Lake/River Classification: —. I Name of Water Body: / r S <br /> Shoreland Agreemt or SIPS Y/N:N Farmland Preservation YIN:A Managed Forestry Law Y/N: /1 <br /> New Parcel Information � <br /> Proposed New Legal Description and Parcel Size: Tf F N�4L U NE E t <br /> SEC /on/ 22 Towk),W/P 3 !' zVoOd Of 2Rti6E J=5: EXCCf37 <br /> T � I6P W rGNT o�W ` PQ &R)15i5D Acres: l® <br /> /°k/ VoL Q li i= V-7V, pnGr_7z- ]3u i7 C0ejr vit5e . REC6Ro5 <br /> (If parcel is to he surveybd,provide prelimina4 map. See attached or preliminary map requirements.) <br /> Proposed access to public road: <br /> m <br /> Proposed access to public waters to be provided Y/N: 0� 2 <br /> If ves,describe access: <br /> i <br /> q � <br /> Signature of Owner: Date: <br /> Signature of Owner: Date: ro <br /> a <br /> e <br /> D Does parcel meet Zoning Requirements? Yes No R <br /> eN �c <br /> Q ➢ Does parcel require a Survey? Yes No O <br /> Permit application fees submitted? ❑ Amount$'5V. D b Receipt# <br /> 1 <br /> Ga <br /> m ❑ Reconciles with Real Property ListerYe , No Date: <br /> a <br /> If not,explain: <br /> a t Y i li 5' N <br /> N <br /> V' <br /> Applicatio Approved nied Reason for Denial: p <br /> Land Use: Date: <br />