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Pccs(must accompany Con): <br /> Burnett County Subdivision Permit Applicatin <br /> on Subdivisionw/o Survey: $50.00 <br /> and/or Pre-A licatio�l Form Survcy of Existing parcel: $50.00/lot <br /> �• �,J re PP Subdivision w/Survcv: $200.00+$50.00/Iol <br /> Owner: J. ///�//L7i/� ` /,G/_'k-.�T/ if,/f Buyer: <br /> A <br /> Address: <br /> /ZA, ZIVZL &lJ%VN•r`t.Cf �2address• B <br /> ''!!�✓ syess <br /> Phone: lis 'T7 Z" Z 7,?.— Phone: CM <br /> n <br /> Original Parcel Information a •� <br /> Parcel ID#: Section .j Z Township 37 Range / <br /> O <br /> Original Description(or attach copy): e <br /> N6 —"E ''• <br /> Cn <br /> Current Zoning: Floodplain Y/N: /t/ Wetlands Y/N: Lake/River Class: -r.. <br /> Nauc of Water Body: Shortland Agreemcat/SIPS Y/N: 4- <br /> Farmland <br /> Farmland Prtscrvatimt Y/N: _ _Managed Forestry Law YlN: a <br /> New Parcel Information <br /> Proposed New Legal Description and Parccl S:rr:: <br /> to <br /> N <br /> R <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. Sec attached for preliminary map requirements.) <br /> Proposed access to public road: G <br /> m <br /> Proposed access to public waters to be provided YIN: '•" <br /> If yes,describe access: <br /> Signature of Owner: Q rerl /O / Date: <br /> Signature of Owner: Date: n <br /> 0 <br /> Y Does parcel nine(Zoning Requirements? Yes No <br /> N <br /> 111777 1 -?-Io <br /> o 'r Does parcel require a Survey? Yes No <br /> P r <br /> v Fermilapplicationjeessubmillerf! ❑ ,imount0 0 Receipl4 <br /> ❑ Reconciles with Real Property Lister 1'rs No Date:— <br /> trout, <br /> ate:Ifout,explain: k) <br /> n C� <br /> o � <br /> a <br /> Application move / med Reason for Denial: n <br /> Lan; <br /> Date: <br />