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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 /> and/or Pre-Application Form or Map Review Form Subdivision wi Survey: $200.00+$50.00/lot <br /> 0-1 b <br /> g R <br /> Owner: 5(.-OTT g M+.1is'1 i.ci- Buyer: d 3 <br /> Address: 2.4-17'7 6A4jr ( Ft.I%G lto4! Address: c <br /> gR4.44g,ta :w1 'i4t4� '� 51 <br /> Phone: 115 - !1-3 i -0�59 Phone: b. `t' <br /> r. <br /> Original Parcel Information <br /> Tax ID#: Z 9 1.4 l• Section 4 L Township Range 1 6 UI <br /> Original Description(or attach copy): S I,U , c14-.v <br /> O <br /> a <br /> rD <br /> Current Zoning: Floodplain YIN: 14 Wetlands YIN: /4 Lake/River Class: 4t4- <br /> Name of Water Body: j.4 ik Shoreland Agreement/SIPS YIN: K <br /> Farmland Preservation YIN: ►.4 Managed Forestry Law YIN: /.4 <br /> New Parcel Information <br /> rG <br /> Proposed New Legal Description and Parcel Size: ..t'k 4 4. G5P'1 1.47r <br /> ; <br /> Acres: 5.VC' <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) 1-3 <br /> Proposed access to public road: y4,0 op LA-Xi--; 12.o,4t7 <br /> G <br /> Proposed access to public waters to be provided YIN: IQ • <br /> If yes,describe access: ....Cs <br /> N <br /> ���Signature of Owner: ' V�� ,f-u) - Date: 1 - a J a va 3 <br /> Signature of Owner: Date: <br /> Fee Rec:z.-. <br /> DV <br /> .� . <br /> ➢ Does parcel meet Zoning Requirements? Yes No = Check#: /0(O 6 <br /> D. Does parcel require a Survey? Yes No rn <br /> o <br /> z ' 11, <br /> o <br /> rn <br /> Reconciles with Real Property Lister Yes No Date: n Po r- <br /> a <br /> If not,explain: > c B <br /> mr^ <br /> y ^� iiTil <br /> n <br /> Application: Approved)Denied Reason for Denial- n 3 <br /> Land Use: Date: u u u <br /> i <br /> b <br />