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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 Pre-Application Form Subdivision w/Survev: $200.00+$50.00/lot <br /> xSNuc-Y L(-:xis <br /> Owner: ((2,t .tnc_A(!>1£ `1—aysr Buyer: .d <br /> Address: \ 0 16cs,c 2—b7— Address: <br /> �� <br /> a- 5�e)c('l <br /> Phone: -7(� ' 8 9 Phone: <br /> Original Parcel Information <br /> Parcel ID Section f, Township G Range( <br /> O <br /> Original Description(or attach copy): o <br /> eo <br /> b Current Zoning: A Floodplain Y/N: Wetlands Y/N: i� Lake/River Class: <br /> v <br /> c <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Information f <br /> Proposed New Legal Description and Parcel Size: � -..'1 e e- c L,L,rc 1 C<, <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: J c�✓+ti:5o�ti �-,j } �„ _ j-�= C <br /> Proposed access to public waters to be provided Y/N: /\,) <br /> If yes,describe access: <br /> Signature of Owner. `_ (�' ,i �.`Z: Date: t- ' <br /> Signature of Owner: t -[ Date: �' j <br /> c <br /> ➢ Does parcel meet Zoning Require ents? Yes No <br /> a <br /> -s <br /> o ➢ Does parcel require a Survey? Yes No <br /> a <br /> °Q ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> r. ❑ Reconciles with Real Property Lister Yes No Date: <br /> er <br /> ° If not,explain: <br /> 0 <br /> a <br /> Application: Approved / Denied Reason for Denial: <br /> Land Use: Date: <br /> D <br /> � c� cadFS <br /> NOV 01 2019 <br /> Burnett County <br /> t_and Services Department <br />