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Fees(must accompany form): <br /> Burnett CounYv Subdivision Permit Application Subdivision w/o Survey: 550.00 <br /> Survey of Existing Parcel: S50.00/lot <br /> art or Pre-Application Form Subdivision w/Survev: $200.00+S50.00/lot 2 0 <br /> Owner: JQjEnu L /n ,DOAACIL _--- Buyer: <br /> Address: 35 2d <br /> Address <br /> Phone: -- <br /> Phone: <br /> Oripinal Parcel lnformationo <br /> Parcel ID#: 7" �'�- y���6- 0.7--3 <br /> SectionTownship S`o.(/ Range <br /> Original Description(or.attach copy): <br /> dI <br /> Current Zoning: // _ Floodplain YA�1• _— Wetlands N <br /> Lake/River Classification: Name of Water Body: <br /> rn <br /> Shoreland Agreemt or SIPS ' V -:Farmland Preservation Y Managed Forestry Law Y <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: I <br /> Acres: <br /> I <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> ✓ f <br /> Proposed access to public road: LD 5 AL <br /> Proposed access to public waters to be provided <br /> 1 <br /> If ves,describe access: <br /> I <br /> Signature of Owner: V Date: I I> <br /> Signature of Owner: -U-01 nth 1 1 -�,ek'l _Date: I S 3 <br /> ti <br /> — c <br /> r Does parcel meet Zoning Requirements? Yes No <br /> o <br /> 2 ➢ Does parcel require a Survey? Yes No <br /> = <br /> Pernti:application fees submitted? 13Amount S 2 S�' v Receipt# <br /> 0 <br /> m ❑ Reconciles with Real Property Lister Yes No Date: SZl <br /> 0 <br /> c <br /> X If not,explain:_ <br /> n � <br /> C 1 <br /> cw O <br /> Application: Approved / Denied/ Reason for Denial: <br /> etA S/' P.tIe/ O !tit P-wt� Li5 <br /> 1 <br /> Land Use: S �� Date <br /> BURNETT COUNTY <br /> ZONING <br />