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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: 550.00 �� <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application Form Subdivision w/survev: 5200.00+$50.00/lot <br /> Owner. 4LLocn4 i 31Z'1AM At-1DErtSe>t-1 Buyer- <br /> .9 <br /> A <br /> Address: 10S7o 4F1,12,g-,,A/ LAuc I~ �> Address: 9 <br /> • / z <br /> Glza�t�S � 2U , WZ <br /> Phone: :T15-' G 89 r Z fi 1 Phone: <br /> Original Parcel Information <br /> Parcel H)#: 3t3-1 -- 30-3 &Z- oeo Section 3o Township 38 Range / Ul <br /> 01400 <br /> Original Description(or attach copy): Fr�.�,•e .n s� 1�2 of 5 t</ 1/¢ Q-)r <br /> -3-3 `f8S'�335 S/ G ��60 <br /> Current Zoning: 4 F7oodplainYm:_n/ Wetlands Y/N: Al Lake/RiverClass: n4 A. <br /> V <br /> m Name of Water Body: A Shoreland Agreement/SIPS Y/N: /V• A . <br /> e <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: A <br /> New Parcel Information �^ <br /> Proposed New Legal Description and Parcel Size: ��fZ-I'b5 sty 1 L c) <br /> o w to ArLL y It// CL, Yo L[OOLJ <br /> L1 5 e t.v,z-5 4/2.o"4ut_-, �M� /�`S lr��i 1J Acres: APK . 4-, s'AG/tC s <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 2C!5 n/(y f�GC -5 S �r5 d <br /> Proposed access to public waters to be provided Y/N: d, . <br /> If yes,describe access: Al, <br /> Signature of Owner: Date: <br /> o <br /> Signature of Owner: T Date: <br /> ➢ Does parcel meet Zoning Requirements? Yes No A <br /> ti <br /> v Y Does parcel require a Survey? Yes No <br /> 0 <br /> P° D Permit application fees submitted? Amount S ID 1 e O�.) Receipt# <br /> r. 11 Reconciles with Real Property Lister Yes No Date: <br /> m <br /> d <br /> If not,explain: <br /> A <br /> 0 <br /> a <br /> w <br /> Apptits; Approved Denied Reason for Denial: <br /> Land Use: C _ �Ci112/Il 3 �/ Date: FEB 19 2016 <br /> BURNETT COUNTY <br /> ZONING <br />