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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+$50.00/lot <br /> L - -1 Laf Sed <br /> Owner: ---)Cl 50‘1\ Lac SO C\ Buyer: 25'c� La" SeC'v IC Qs b <br /> `K <br /> n 0 a3 Rs, +cr og• h.e.e4S s <br /> Address: 41 2.A- ��-C1S)��� a Address: <br /> ir.\o s\-vA--- V.. 1 `) `c Rei•. , fop <br /> G <br /> Phone: Phone: 'SD <br /> .ig. <br /> Original Parcel Information <br /> Parcel ID#: \ C.X 1 '0 1( (oto'Z Section 7 Township 39 Range 15 <br /> Original Description(or attach copy): <br /> V <br /> / O <br /> .0 Current Zoning: U t t6"Floodplain Y/N: ,4! Wetlands Y/N: ✓� Lake/River Class: A'� - <br /> A" Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: O <br /> 1 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: L r 1r <br /> Acres: <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C <br /> IN <br /> Proposed access to public waters to be provided Y/N: "-Di <br /> If yes, describe access: <br /> 4,4,10,---,- <br /> Signature of Owner: G4/ln�J Date: --- /- 7.-6 <br /> Signature of Owner: Date: o <br /> 2 <br /> Y Does parcel meet Zoning Requirements? Yes No av 2._ <br /> N Y Does parcel require a Survey? Yes No /eC� 873O <br /> //Za Z <br /> °Q Permit application fees submitted? El Amount$ -� ' �� Receipt# cs <br /> 1 <br /> �., E Reconciles with Real Property Lister es No Date: q 11/� FL) <br /> 0 <br /> a. If not,explain: 01-Oab-a - 1- i5 -09 - 4 04-000-011Oc0 <br /> n <br /> © <br /> c <br /> w <br /> Applicatio Denied Reason for Denial: <br /> Land Use:' 9 9 2-0 z0 Date: <br />