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bees(must accompany tormp <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parcel: 550.00/lot <br /> and/or Pre-Application <br /> Form Subdivision <br /> �w/Survev: 5200.00+550.00/lot <br /> Owner: 1L U lQ ll Ill d d /(/ //E�14° Buver. <br /> ro <br /> � l� Q�e LZJ <br /> Address: Zb Address: � <br /> &(�� /,/-/e, /))N 559/f <br /> Phone: Lit 56 7 Phone: <br /> f c_ l5- /Z8- ` /Z-Z- ye- io- � t11 <br /> /�-J Onainal Parcel Information / )- /2 g a -75C>If5'�5 <br /> ParcelID#: 6--/Y�-' Section M Township ydN Range <br /> Original Description 'or attach copy): A!L�� zr�I Z2ti6 t h <br /> 0 <br /> a <br /> d Current Zoning: L1 p Floodplain YWetlands Y& <br /> o f'�I: � <br /> Lake/River Classification: Name of Water Body: <br /> Shareland Agreemt or SIPS Yt�) Farmland Preservation Y/n Managed Forestry Law Y� <br /> New Parcel Information, / p <br /> Proposed New Legal Description and Parcel Size: C�'m ✓/ �1/ C. o <br /> Acres: _ <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> I <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Ye. <br /> If ves,describe access: <br /> 522 U <br /> Signature of Owner: Date: ' <br /> Signature of Owner: Date: <br /> A Does parcel meet Zoning Requirements? Yes No <br /> o <br /> ➢ Does parcel require a.Survey? Yes No <br /> a <br /> r`e Permit application fees submitted? Amount S-5D 6Ol / Receipt# _ <br /> w <br /> ❑ Reconciles with Real Property Lister Yes No Date: _ <br /> 0 <br /> c <br /> If not,explain: -- --- <br /> c -- <br /> Application: Approved i Denied Reason for Denial: <br /> Land Use: Date:_ <br />