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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: $50.00flot <br />and/or Pre -Application Form Subdivision w/ Survev: S200.00+S50.00/lot <br />Owner: 1 1 w, v\ 0 Buyer: .9 <br />VV, 1 <br />Address: (Q "I' i4Address: <br />R <br />T7 ly) .0 6-,5-0'10 <br />Phone: tQ is - a a I - -2(o 8'1 Phone: <br />Original Parcel Information fa <br />c7 -c36 -a -40-17-3(A-5 15-g10-0300oI v` <br />Pa reel 1D#: /--- qaa-03cI(D0 Section 36 Township Ll0 Range <br />III O <br />Original Description (or attach copy): <-ct.�e. U l e w 4g lurLS + / FS 41% 3 0 <br />�- i.C'_ke_ v; eW S 40+s 114' ao) +moi 8'-k 3 <br />Current Zoning: FloodplainWetlands Lake/River Class: <br />Name of Water Body: <br />Shoreland Agreement/SIPS 1(/N� <br />Farmland Preservation Y N� Managed Forestry Law /N:I <br />New Parcel Information V �, cj <br />Proposed New Legal Description and Parcel Size: /Ve i D 1 /' A C,5 M <br />Acres: (O <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: S r'_ ,:i <br />Proposed access to public waters to be provided YIN: <br />If yes, describe access: <br />Signature of Owner: <br />Signature of Owner: <br />Date: <br />Date: <br />> Does parcel meet Zoning Requirements? Yes No <br />> Does parcel require a Survey? <br />Permit application fees submitted? <br />❑ Reconciles with Real Property Lister Yes <br />If not, explain: <br />Yes No <br />Amount S �� o or Receipt # <br />Application: Approved / Denied Reason for Denial: <br />Land Use: <br />No Date: <br />=S, j Date: BURNETT COUNTY <br />ZONING <br />