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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+$50.00/lot <br /> Owner: -�r L-Y Buyer: 7�:>AU IY 61 ,/4� �t 1p �/ Mu17 <br /> Address: G�I / Suit�/'C�\ F^� Address: Z43&L l K '?ar <br /> r <br /> Phone: ts- Phone: <br /> 4- <br /> Original Parcel Information ..D <br /> i <br /> Parcel ID#: -074) . /6 / -y Section 5 Township Range /6 W wD <br /> ©y-tw - C11L 0 <br /> Original Description(or attach copy): _S C NY) x <br /> r � <br /> .a Current Zoning: .' �% Floodplain Y/N: /� Wetlands Y/N: ke/River Class: <br /> ors <br /> Name of Water Body /V 14 Shoreland A eement/SIPS Y/N: <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: <br /> New Parcel Informattinion <br /> Proposed New Legal Description and Parcel Size: �� �t�A,.J,'A -- <br /> Acres: 1 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: IV/ AI' <br /> m <br /> Proposed access to public waters to be provided Y/N: /1111/ <br /> If yes,describe access: <br /> t <br /> Signature of Owner: Date: <br /> Signature of Owner. Date: c <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N � <br /> ➢ Does parcel require a Survey? Yes No <br /> o' <br /> °Q ➢ Permit application fees submitted? ❑ Amount$ lit <br /> '_- <br /> r. ❑ Reconciles with Real Property Lister Yes No Date: <br /> o F¢ If not,explain: <br /> 0 <br /> -s <br /> a <br /> H — 3 U9 <br /> Applicati Approved /J&nied Reason for Denial: <br /> Burnett County <br /> on <br /> Land Use: Date: <br />