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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: $50.00Aot <br /> and/or Pre-Application Form Subdivision w/Survev: $200.00+$50.00/lot <br /> ONNuer: —L-O <br /> 1 T Buyer: y <br /> n <br /> 3 <br /> Address: 1034- C't;VNTy (ZP (= Address: <br /> 5pcoN r/Z ►,f L 54-801 z <br /> li`t <br /> Phone: "715 639 9 Z 7 S Phone: <br /> Orieinal Parcel Information 'f <br /> OZ 641Zq-0'7700 ' <br /> Parcel ID#: e>-L 64 1 Z 4o $ 1 0o Section 04- Township 4 c Range <br /> O <br /> Original Description(or attach copy): ATCACHCts <br /> n Current Zoning: (ZR 3 Floodplain Y/N:---y Wetlands Y/N:_ Lake/River Class: <br /> y Name of Water Body: IHS ICrrN-?=1 t✓ LRKC Shoreland Agreement/SIPS Y/N: y co Lcr <br /> Me- KG—t t cntz c-c 1� <br /> Farmland Preservation Y/N: tJ Managed Forestry Law Y/N: ri <br /> New Parcel Information C?srn U a�P ab7 a <br /> Proposed New Legal Description and Parcel Size: Itit S IS P- 12a5L aVe4 o¢ l—ir/,- <br /> NG PAR.CCIS <br /> .Acres: } <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: G-1'Ft F�r d <br /> Proposed access to public waters to be provided Y/N: <br /> If yes, describe acce <br /> i <br /> Signature of Owner: 1 Date: <br /> Signature of Owner: Date: 3 <br /> t <br /> e <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> 0 <br /> ➢ Does parcel require a Survey? Yes No <br /> o' <br /> °0 ➢ Permit application fees submitted? Amount S Receipt# <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> L <br /> 7 <br /> If not,explain: <br /> X <br /> n <br /> 0 <br /> •S <br /> C <br /> r <br /> Application Approved / enied Reason for Denial: <br /> Land Use: fr Date: BURNETT COUNTY <br /> ZONINU <br />