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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: $200.00+S50.00nol <br /> o"C-fLs <br /> Owner: mc N M D, SAV N D aMS, 4 Buyer: ,a <br /> Address: 5!0 y a Co V I rJ G-ro nl L IJ Address: <br /> 5Homc- woov M#J -55331 <br /> 0 <br /> Phone: 95 Z 893 8 z*�9 Phone: <br /> Orieinal Parcel Information <br /> 02.043 tool too -� <br /> Parcel ID#: oZo¢3 IooI -Loo Section jO Township 40 Rangel( <br /> O <br /> Original Description (or attach copy): _ VOL 580 P. 593 ATfAr-Har_ > <br /> A <br /> D <br /> a <br /> Current Zoning: RR-Z. Floodplain V/N: N Wetlands V/N: N Lake/River Class: 7- <br /> Name <br /> Name of Water Body: l-y V E L A V-8 Shoreland Agreement/SIPS Y/N: /y/A <br /> 5 � <br /> Farmland Preservation V/N: N�j - Managed Forestry Law V/N: N/A <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: oN m 60 r 1'0'F B y m <br /> Gtz—a-n FIE17 502Vis) <br /> Acres: 1 1 , 4- <br /> (if <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 8y Pfzi V ATE TLoP.P O <br /> Proposed access to public waters to be provided Y/N: iV�/} <br /> i <br /> If yes,describe access: <br /> J <br /> Signature of Owner: Date: S''`( 10 9 Q <br /> Signature of Owner: 'fur Z't G n..Marf Date: o <br /> 9 <br /> t <br /> Does parcel meet Zoning Requirements? Yes.. No �co Sv�G�rtASc'r (fa�Lu-� <br /> � Y Does parcel require a Survey:? C-yelNo� c Q <br /> R> v <br /> °Q y Permit application fees submitted? ❑ Amount$ ' C)0 Receipt# 6 <br /> s <br /> W <br /> r ❑ Reconciles with Real Property Lister Yes No Date: d O <br /> 2 0 <br /> If not,explain:__ <br /> C Q d <br /> Applicatio Approved / nied Reason for Denial: <br /> Land Use: Date: <br />