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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: $50.00/1ot <br /> and/or Pre-Application Form Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: K AV Buyer: b <br /> Address: Z 3 ���t �� r' Address: <br /> Phone: lS - �'— �� Phone: <br /> t <br /> Orisinal Parcel Information .p <br /> o'r.oi0 -z-� -��-o�- I c3-oc�o-vt►ooc� <br /> Parcel ID#:07-cn8 Z-3'1-k(�-c_-15 Section Township 3� Range lG, <br /> O <br /> Original Description(or attach copy): o <br /> A <br /> Current Zoning: ' \� Floodplsin Y/N: <br /> __�_Wetlands YIN: Lake/River Class: <br /> w Name of Water Body: �e !(ac.� Shoreland Agreement/SIPS Y/N: �.3 <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: J V\_ '� d <br /> s� <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> Signature of Owner: Date: ! �� <br /> Signature of Owner: Date: <br /> G� l <br /> D Does parcel meet Zoning Requirements. Yes No <br /> Does parcel require a Survey? Yes No n <br /> oa � Sly � N <br /> ➢ Permit application,fees submitted. ❑ Amount$ Receipt# W <br /> J b <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> 0 <br /> If not,explain: JV N <br /> A <br /> 0 <br /> �s <br /> a <br /> y <br /> Application: Approved / Denied Reason for Denial: <br /> Land Date: <br /> l � D <br /> c°•UA�/y 7X6- Scr�1 e S/2 e, ga V81 2019 <br /> Burnett County <br /> Land Services Department <br />