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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 w/Survey: $200.00+$50.00/lot <br /> co a <br /> Owner: s l moony 4- 1-7e loom 6 nz 171 uyer: ei <br /> C <br /> Address: '15 h 671 t f r Address: n <br /> maple (/a/Cep ,- ci <br /> Phone: Phone: A <br /> Original Parcel Information R <br /> Tax ID#: 223 / Section 36 Township 1i____Range /6 0 <br /> Original Description(or attach copy): -/ /Nr �t-.'"5 IA) 1p <br /> ft 6 •► <br /> m <br /> Current Zoning: 0-4loodplain Y/N: Wetlands Y/N: Lake/River Class. 1 <br /> Name of Water Body: Shoreland Agreement/SIPS Y/N: M '� <br /> a <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: > <br /> 0 <br /> New Parcel Information r <br /> • <br /> �,�/J <br /> Proposed New Legal Description and Parcel Size: <br /> v`t� /p l- c_ Ai L P <br /> m <br /> 0 <br /> . <br /> Acres. <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: G <br /> Proposed access to public waters to be provided Y/N: ).) n <br /> >ti <br /> If yes,describe access: Ar/ — " WSignature of Owner: r`� - t��� Date: /� �02 T V\ <br /> . ,ssi '.:OlF'..11gltP4lle,w.__ b i 1/2/d t"( <br /> Signature of Owner: %At�f �' Date: <br /> Fee Rec: 75* — <br /> 00 <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> Check#: /�f <br /> ➢ Does parcel require a Survey? Yes No f�o G5444 f <br /> Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> Applicati : pproved / enied Reason for Denial. <br /> Land Use Date: <br /> - ØØv <br />