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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdi%ision v,o Survey: S50.00 <br /> and/or Pre-Application Form Survey of Existing Parcel: S50.00not <br /> ` PP Subdivision u' Survev: 5200.00-S50.00,'lot <br /> L <br /> Owner: SEI� [L 1 A'LZ: CGrY lt,t� _ Buyer: <br /> ((}} rs <br /> Address:_t'U Address: <br /> Phone: Phone: <br /> Original Parcel Information <br /> Parcel ID#: G 1- Section g; Township 3 'h Range (5(t t <br /> � <br /> Original Description(or attach copy): S i c.' T X-1� Su '�`/ �D� � ! •3 71_' <br /> z <br /> C� <br /> r �,. <br /> Current Zoning: J� `"P'`Floodplain)6N;1 �_ <br /> R'etland �'_ : Lake/River Class: /�- A <br /> Name of Water Bodv: Lyzl Shoreland Agreement/SIPS Y(S- .` <br /> Farmland Preservation Y ; lianaged Forestry Law Y <br /> New Parcel Information <br /> r' <br /> Proposed New Legal Description and Parcel Size: SG �i'��i-rt ��� /✓l fpS <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 /> v m <br /> Proposed access to public waters to be provided '. <br /> If yes,describe access: s <br /> S ded Land Company Lry���`'"� O <br /> Signature of Owner: Date:__ J/-C j—•,2�j c1 <br /> ,:2!es W. Smith <br /> Signature of Owner, Date: <br /> Does parcel nteet Zoning Requirements? Yes 'Yo J1_ 59L�Q"] <br /> �/ 11 �t / <br /> > Does parcel require a Sunvr? Yes .Yo ' <br /> Permit application fees submitted.' ❑ Amount S ' Receipt <br /> Reconciles with Real Property Lister Yes \o Date: <br /> xIf not,explain: <br /> c <br /> z <br /> Applicatio Approved / nied Reason for Denial: <br /> ------------ <br /> Land Use: 010 Date: <br />