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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 or Map Review Form Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner: .S r/.17/7--71) V //1 /l CI/l) Buyer: �Q Q/A,) LJ 6/0 .74 .(J e/� �J' <br /> Address: 2/7 7 2 J7 7 /CZ 3 5 Address: 3)7V i �• —if TLS ✓1. \/� <br /> 1s` <br /> b4/08u2 c;/ 0) / ,vfrAlnci2 Ui Ldi 5.f R36 <br /> Phone: /..5 - 3 ,S Phone: M5-- /S-3 - `1/01/ O <br /> Original Parcel InformationCD <br /> vo-cid' -o/30d a cA <br /> Parcel ID#: 6'7 /5 -4).5- Section Township ">// Range /47) <br /> Original Description (or attach copy): <br /> Current Zoning: ieLQ Floodplain Y/N: /VC0 Wetlands Y/N: /CO Lake/River Class: /IL.4 <br /> CS'• <br /> o Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: Alt) Managed Forestry Law Y/N: ,i t <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: / J oc, Cl(7e S /p✓' r S 7L4'fe <br /> ' a d 35 Nog 77/ ✓°ore Po/V 68.427 d& i r a�'�7c�ti/ a?d 9 �' ✓4/2 c' <br /> �0�e <br /> \T<)Ui3fN Erb ‘351,,),V (Gt 1-7,, 4Y1�'�2) Acres: /. 5,ZID 13E /40)050 7e .�G c r�'� k9f iS i (•- c:,1c.. 5 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road• ill a <br /> Proposed access to public waters to be provided Y/N: j(h) <br /> If yes, describe access: <br /> Signature of Owner: = h!.. Date: i/ /J —• � <br /> Signature of Owner: Date: <br /> ). lAte- / /l s� <br /> Does parcel meet Zoning Requirements? Yes No 9 � <br /> 0 > Does parcel require a Survey? Yes No �� <br /> cra <br /> 5 ➢ Permit application fees submitted? 0 Amount$ • Receipt# <br /> 0 Reconciles with Real Property Lister Yes No Date: <br /> r <br /> If not,explain: <br /> a. <br /> a <br /> °• Application Approved / enied Reason for Denial: <br /> Land Use: 9/18/2.02.9 Date: <br /> U Se. JSGY1/MN a 5 DYv,Se4' ON /1 P ,age-, <br />