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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 /> �� -�� C/ ��/h� Tff!1� <br /> Owner: (/i/ O / w c.7 Buyer: c`.A/ /1/0049. .. DNT`OT/ 9 <br /> Address: 72772,,c,,(.6ds /�ple Address: //90 fiLLf/z LANr< o <br /> /GL.-t.Jifd/ Zd/ 648. 8 O /u //ids , q&) .53//Z cAcA <br /> Phone: 7/5 5-5 7 -‘37 ‘ Phone: 6.5/ .??08 - D835- )0 <br /> Original Parcel Information .I <br /> W <br /> Parcel ID It: 03 735 Section 3f$6 Township 7/ Range / <br /> O <br /> Original Description(or attach copy): 4 <br /> ieb <br /> 2 1-or 7M NE ' -4' A 2c, es r"0/1/4)N /2/6 LJ <br /> is:-/ SAND 2 / O� <br /> Current Zoning:�fh," Floodplain Y/N: Wetlands Y/N: A Lake/River Class:, •/' <br /> Name of Water Body: /, itJt2✓/4 Shoreland Agreement/SIPS Y/N` / iv Q <br /> Fr Farmland Preservation Y/N: N Managed Forestry Law Y/N: A/ <br /> New Parcel Information 4 CS 4 R <br /> Proposed New Legal Description and Parcel Size: TWD Du T!-dT5 Ft, <br /> a4//614 / - 0.ey,¢e, vaTGOT Z - `. fZ / ' <br /> Acres: -7 3/ 4114. / <br /> TT— <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) G <br /> a <br /> Proposed access to public road: A44)G <br /> ti <br /> Proposed access to public waters to be provided Y/N: 7 6' <br /> If yes,describe access: <br /> 7 E' <br /> Signature of Owner: Date: %�3 / <br /> Signature of Owner: Date: <br /> ) Does parcel meet Zoning Requirements? Yes No C <br /> Z Co 3 9 w <br /> J <br /> ➢ Does parcel require a Survey? Yes No GI <br /> a W <br /> aro ➢ Permit application fees submitted? pr, Amount$ OC>.00 Receipt# <br /> ®Reconciles with Real Property Lister ® No Date: a_g-a2,0a/ <br /> r <br /> a If not,explain: <br /> a <br /> a. <br /> eo <br /> a <br /> a <br /> a <br /> co Application pproved enied Reason for Denial: <br /> Land Use: Date: <br />