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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/oJr Pre-Application Form Subdivision wiSurvev: $200.00+a50.o0nnt <br /> Owner: 1Q1 1 Ui('Q,f 0 Q1 6 Utx- Buyer: y <br /> Address: 2 b�] (�1�I Address: 3 <br /> Phone: 7 I Phone: <br /> v3y— iyyq_Lit gaa Ori inalParcelInformato <br /> b'1N-R�2`�Oti q ����� <br /> Parcel ID#: ()3'✓'�9�2 5' O r'Z�� Section a2 9 Township 37� Range Q.r�L <br /> o�Y _9�zg.-o 3cn/ o <br /> Original Description(or attach copy): l7• e <br /> A <br /> /ALL Lor 7 aoc 651ny-7 p /i� ALL Loy- � ' o <br /> oFp <br /> and Duyif 3 Play of- Aber fi -y d inVZ '0 /Za " r <br /> C e3 <br /> Current Zoning: — Floodplai6N: Wetland�I�'N: / /, �fi k <br /> Lake/River Classification: / Name of Water Body: t�t trU u e G—Ge/� F <br /> Shoreland Agreemt or SIPS Y6--Farmland Preservation Y)6----Managed Forestry Law Y�_ . <br /> New Parcel Information 3e <br /> Proposed New Legal Description and Parcel Size: <br /> LR <br /> Acres: 3. yw <br /> 6 <br /> (If parcel is to be surveyed, provide/preliminary <br /> map. <br /> ,See attached for preliminary map requirements.) � <br /> Proposed access to public road: <br /> m <br /> Proposed access to public waters to be provided YQ g <br /> If ves,describe access: <br /> c1 <br /> bN Signature of Owner: - - Dater <br /> 0 <br /> °0 Signature of Owner: Date: o <br /> 3 <br /> 9 <br /> ➢ Does parcel meet Zoning Requirements? Yes No m <br /> D Does parcel require a Survey? Yes No <br /> CL <br /> Q vW W <br /> D Permit application fees submitted? ❑ Amount$ ` Receipt# I �;2 / { <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: , w 9J <br /> �o 00 <br /> W <br /> c <br /> Q <br /> Application: Approved / Denied Reason for Denial: <br /> Land Use: Date: <br />