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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> and/or Pre-Application Form Survey of Existing Parcel: $50.00/lot <br /> [ „ PP Subdivision wI Survev: $200.00+$50.00/lot <br /> Owner: !,t-(�I1lt//YI.(t pn� ko /V�Q,I—I Buyer: „e <br /> Address: Address: a <br /> la�pa>a a 5yg <br /> Phone: Phone: w <br /> Oriffinal Parcel Information 4CJj <br /> Parce[ID#: D/Y� _ ) 7 ��— D J ZOD _SectionAQ TownshipJW <br /> / Range r <br /> ` fir <br /> L <br /> O <br /> Original Description(or attach copy): AJ L /t/C EX PCL. V /Q2y� F <br /> 0 <br /> A <br /> a 0) <br /> W Current Zoning: U 700eA Floodplain Yd Wetlands Yl <br /> Lake/River Classification: Name of Water Body: <br /> G <br /> Shoreland Agreemt or SIPS Y&': _Farmland Preservation YQ Managed Forestry Law Y -): <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: 02 7� <br /> (If parcel is to be surveyed,provide preliminary map. <br /> See attached for preliminary map requirements.) <br /> Proposed access to public road: "WM <br /> m <br /> Proposed access to public waters to be provided Y(9 <br /> If ves, describe access: <br /> U <br /> c Signature of Owner: Date: y Z Z d� C <br /> e <br /> C) <br /> C4 <br /> °Q Signature of Owner: Date: e <br /> 3 <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> ➢ Does parcel require a Survey? C No <br /> o, i � <br /> D Permit application fees submitted? ❑ Amount$ �D D C) Receipt# 1 �b <br /> n \ <br /> 0 <br /> a <br /> '^ <br /> El Reconciles with Real Property Lister Yes No Date: � <br /> If not,explain: <br /> c <br /> Q <br /> 1 <br /> Applicatio Approved Denied Reason for Denial: <br /> Q <br /> Land Use: Date: S'2J'— <br />