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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 Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: �17 G wz� Buyer: b <br /> A <br /> Address: 441QSRO Address: 3 <br /> S19*.�1 <br /> _ q cn <br /> Phone: -11 ��'�r�3 1 Phone: <br /> I <br /> Original Parcel Information l� <br /> C042 Z¢Z '20 LL00 (n <br /> Parcel ID#: nZ-Cb o& .. 2--3A - i7- Z7-3 Section 2-1 Townshie_ Range�� C7 <br /> G3- 000- 611100 � <br /> Original Description(or attach copy): c:SM A,xrAcC ICD <br /> K\ 0-2- <br /> o Current Zoning:�Floodplain Y/N: _Wetlands Y/N: c M C Lake/River Class: 5TR-W^w� S_ <br /> Name of Water Body: Nlooa Rtyl=R- Shoreland Agreement/SIPS Y/N: t.l <br /> o (0 <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: 1J <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: [4CC0W r-16uzE Z P^R-CC-(.S A'S <br /> a5 P baa—a�� <br /> Acres: Z+ t- <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 0 i; C pp,tzeC--c_ W t L-A- HAVa Po,1 C-h5Ew1 t�►%JT- d <br /> A <br /> Proposed access to public waters to be provided Y/N: ?J <br /> If yes, describe access: <br /> Signature ofOwner:ZDN 2Lt\ Date: _\ 3 <br /> Signature of Owner: Date: 3 <br /> e <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> o ➢ Does parcel require a Survey? Yes No <br /> m <br /> o <br /> Q0 ➢ Permit application fees submitted? Amount$ 3Qd ' Receipt# <br /> ❑ Reconciles with Real Property Lister / \Yes No Date: <br /> d <br /> 0 <br /> a If not,explain: <br /> RPP - 2 2AIqn <br /> 0 <br /> Z <br /> C <br /> w <br /> Application: Approved / Denied Reason for Denial: BURNETT COUNTY <br /> e to r' o ZONING <br /> Date: <br /> Land Use: <br />