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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: $50.00 <br /> and/or Pre-Application Form or Map Review Form Survey of Existing Parcel: $50.00/lot <br /> }�ddmatj Lei viJ0) t72,0 Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: _L;�&tLlaA kJLSL.Cl/ntn/r Bu er: <br /> CC ( 3 <br /> Address: �� � L l� I �C LA dress: ' <br /> IIVVI bid o <br /> 63 <br /> Phone: Phone: _r_ <br /> 'i7-O�2'Z'ND-irT Z5—5 OrielnaIParcellnformation <br /> Parcel ID#: D��/ 02��ctionZ Towns 5 pRange <br /> /hi /7a� a �✓ O <br /> Original Description (or attach copy): lel PR11-ee 1)1101 do[ 3y934u =° <br /> t� <br /> Current Zoning: 1\f) 1 Floodplai '& WetlandtY : <br /> Lake/RiverClass: I <br /> Name of Water Body:IV l7 r Wf tit / s�l�� l hS t re ent/SIPS Y& 3 <br /> (` <br /> Farmland Preservation Y/ fA: Managed Forestry Law Y <br /> New Parcel Information — <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: 5 8 <br /> (If parcel is to be surveyed,provide preliminary map. See att,,ac(heed for preli inary map requirements.) <br /> Proposed access to public road: ��-'t—� - �a� <br /> /rt <br /> Proposed access to public waters to be provided Y& S?/Nli Cof v I <br /> If yes,describe access: <br /> Signature of Owner: Date: <br /> n <br /> Signature of Owner: Date: <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> x <br /> N ➢ Does parcel require a Survey? Yes No <br /> o <br /> o <br /> Permit application fees submitted? ❑ Amount$ 50•C> U Receipt# Aj� <br /> .G <br /> ❑ Reconciles with Real Property Lister Yes No Date: P <br /> V <br /> r <br /> � If not,explain: <br /> a cit <br /> A� <br /> It <br /> l <br /> 0 <br /> ., o <br /> y Application: Approved / Denied Reason for Denial: <br /> 0 <br /> Land Use: Date: 9.> <br /> J <br /> 0 <br /> 0 <br /> 0 <br />