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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 /> 1, ...1itCO ft <br /> Owner: k E1 #0 Y ( Buyer: J et- kizs'�m' sEA,' C 3 <br /> I ?rT31 Ca44ITY I D 4' o <br /> Address: ��E�- �� � Address: <br /> P1 & e. l S '3 - e-VM.J73 i3iu?4= Z SY D . <br /> Phone: l 5 �' ee 0 6a Phone: /' - 3 vZ 3 b.).p <br /> Original Parcel Information 0 <br /> Tax ID#: 2PI I Lp Q Section Zed Township 3 g Range 1?, <br /> 4 <br /> Original Description (or attach copy): 61,0 -4)G. Q,,4cJ4- L_o.\- 1 C Sn'1 3518 ti 0 <br /> o <br /> C7 <br /> m li <br /> a f� <br /> 4-0441 Zoh ei d R <br /> Current Zoning. Floodplain YIN: Wetlands Y/N: Lake/River Class: . <br /> pi <br /> Name of Water Body: Shoreland Agreement/SIPS YIN: c \ <br /> Farmland Preservation YIN: Managed Forestry Law YIN: > c <br /> 0 <br /> New Parcel Information <br /> z <br /> Proposed New Legal Description and Parcel Size: 1-.Z-1" I 1 1--L:Y' -2 - <br /> rt <br /> 0 <br /> Acres: b <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) X <br /> Proposed access to public road: 5 <br /> Proposed access to public waters to be provided Y/N: <br /> If yes, describe access:` <br /> Signature of Owner: 0C, �.--- Date: <br /> Signature of Owner: Date: S' 7 - <br /> Fee Rec 3 <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> Check#: <br /> ➢ Does parcel require a Survey? Yes No <br /> AKd a r.G.a� r <br /> Reconciles with Real Property Lister Yes No Date: L __ 1570 <br /> ga <br /> If not,explain W c <br /> m , <br /> a ffli <br /> c�1 <br /> o co <br /> S a 41 <br /> w s< <br /> Applicatio Approved enie R n for Denial• u u i <br /> CD <br /> Land Use: _IA, - /0702770e ZV Date: / = I J� <br /> 4/s is a s4'f d 5/ 4 opM en 7L {ar .fie. 2ose1 ore-A 0 <br />