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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 /> //�� <br /> and/or <br /> �[Pre-Application Form Subdivision w/Survey: 5200.00+$50.00/lot <br /> Owner: `�\. J 1 1 1 a" ' no- '_- �i Yom-Buyer: mz <br /> rO�i lrL C <br /> Address: I l3a l/rNerri Ln Address: i. <br /> 2Oz <br /> r l\ -4 i kk MY) v 5 3c ?KZ <br /> Phone: LO 1a" O 0 a '1 5e t Phone: ii <br /> Original Parcel Information <br /> O` 00! -011100 <br /> Parcel ID#:©1- O i' —D•39 — I L-33`1 Section 33 Township 341 Range 14e <br /> OM" <br /> Original Description(or attach copy): 5 E`I4 E.. Loi I Cpm 5 1 11 V? Q 5a 4 <br /> a <br /> n <br /> •a Current Zoning: 4 Floodplain YIN: Wetlands Y/N: �" Lake/River Class: E <br /> n Name of Water Body: I IA Shoreland Agreement/SIPS Y/N: <br /> T n, <br /> Farmland Preservation Y/N: 1 v Managed Forestry Law Y/N: N p,� <br /> C <br /> New Parcel Information •�S <br /> Proposed New Legal Description and Parcel Size: 3 uov 5uAge,vm ;-:7-, r <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: t7 <br /> a� <br /> et <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> .. "•••1 <br /> Signature of Owner: Date: e <br /> Signature of Owner: Date: No <br /> 9 <br /> o <br /> c <br /> N <br /> > Does parcel meet Zoning Requirements? Yes No /_ Gas-97 <br /> o D Does parcel require a Survey? Yes No (�- <br /> Permit application fees submitted? ❑ Amount$ 3 5.19 Receipt# 6"- <br /> ®Reconciles with Real Property Lister 00 <br /> a p ty �� No Date: 7-12-Z'L <br /> a <br /> a. If not,explain: <br /> n <br /> o <br /> 0 <br /> 1 <br /> a <br /> Applicatio : Approved / Denied Reason for Denial: <br /> Land Use Date: 7///ze, 2.Z____ <br />