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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 re -Application Form Subdivision ,Yl Survey: $200.00+$50.00/lot <br />,— <br />Owner. Buyer: lJ n �f� ` ✓e'.� r ��.s1L;u� .' <br />i <br />Address: Address: <br />Address: 3. <br />Phone: Phone: <br />/� ✓� Original Parcel Information <br />Parcel ID #: ��3 L �j Section Township Range <br />Original Description (or attach copy): �iC� �p�� ILS <br />Current Zoning: C_ I Floodplain YIN: Wetland Y i': Lake/River Class: <br />Name of Water Body: Shoreland Agreement/SIPS YIN: <br />0 <br />R Farmland PreservationY IVlanaged Forestry Law Y/N: <br />New Parcel Information// <br />Proposed New Legal Description and Parcel Size: AleA � I let <br />Acres: 7NQ, <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br />Proposed access to public road: <br />Proposed access to public waters to be provided Y/N: <br />If yes, describe access: <br />Signature of Owner: Date: <br />Signature of Owner: Date: <br />> Does parcel meet Zoning, Requirements? Yes tVo eC- <br />tv c k- $- <br />Does parcel require a Survey? Yes Ivo <br />> Permit application fees submitted? ❑ Amount $ Z✓�Q, o Receipt r <br />�. ❑ Reconciles with Real Property Lister Yes No Date: <br />n <br />If not, explain: <br />N <br />n <br />0 <br />c <br />Application pproved / enied Reason for Denial: <br />na Q�CSf k6c?d W S i S <br />Land Use: Z / Date: <br />-,O <br />W <br />O <br />v <br />A <br />