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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/Survey: $200.00+$50.00/lot <br /> Owner: 7 a.v 4., ,'7r-r-1, :,Ti:-:. ► i Buyer: <br /> b <br /> CD <br /> Address: Z 77" f S Ri-r:t,1. rr� t.w1,i;...: A-. rf? Address: 3 <br /> '..,14,1,_(-, ..-1`I -% v' t t trl" t t a <br /> c., <br /> Phone Phone: tP <br /> Original Parcel Information lV <br /> O <br /> Parcel ID#: Cr -4 C -1 ;e4 i 4't v ? i14 is C17 Section ,j Township 44-' Range /k-° <br /> tt G r'.' O <br /> Original Description(or attach copy): ii.. v./ <br /> 0 <br /> A <br /> Z <br /> Current Zoning: 4 Floodplain Y/N: tV Wetlands Y/N: /v Lake/River Class: <br /> a Name of Water Body: Shoreland Agreement/SIPS YIN: <br /> Farmland Preservation YIN: ,'y Managed Forestry Law Y/N: t\: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: t,.1 t;.d.{ i...'t 3 <br /> Acres: Z. 7 c. <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> !v <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: tr- <br /> Signature of Owner: ''Date:' <br /> Signature of Owner: Date: <br /> a <br /> 3 <br /> Does parcel meet Zoning Requirements? Yes No ° <br /> > Does parcel require a Survey? Yes No <br /> O W <br /> 00 <br /> > Permit application fees submitted? 0 Amount$ <br /> 7�l/i�.--- Receipt# 0 <br /> 1 <br /> ® Reconciles with Real Property Lister es No Date: (o/aq/ap <br /> 0 <br /> °• If not,explain: <br /> 74n <br /> n <br /> 0 <br /> a <br /> W3 <br /> Applicatio Approved Denie ' Reaso for Depial: <br /> pIt " o - e r $ a Rea <br /> )� <br /> Land Use: <br /> /llo z0 2e:52 Date: <br />