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Burnett County Subdivision Permit Application Fees dimsonwoSurvey:form): <br /> and/or Pre-Application Form Survey of Existing Parcel: $50.00/lot <br /> Subdivision w/Survev: $200.00+$50.00/lot <br /> Owner: �//J�� / a4le— =�(/� Buyer: <br /> Address: JL512L L-le ee <br /> Address: 3 <br /> Phone: Phone: (JW <br /> Original Parcel Information <br /> Parcel ID#: d�L5X7- /5 276)( Section 'Z Township <br /> A,11vV 0Range �n I�COOriginal Description (or attach copy): X <br /> ' <br /> C2.6 1 o <br /> Current Zoning: ,/C-� Floodplain ] N: Wetland6;}N: 4- <br /> _ <br /> Lake/River Classification: Name of Water Body: 4// /I p— <br /> Shoreland Agreemt or SIPS Ye.—Farmland Preservation Yo_Managed Forestry Law YA I�• � <br /> New Parcel In�fformation R <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: [o <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: /'� V'e. <br /> Proposed access to public waters dto be provide <br /> Ifves, describe access: 44Ar Cof 6� <br /> c Signature of Owner: <br /> e <br /> 'd A- Date: 3 <br /> _ e <br /> Signature of Owner: <br /> Date: (� <br /> 0 <br /> ➢ Does parcel meet Zoning Requirements? Yes <br /> 3 <br /> No c <br /> ➢ Does parcel require a Survey? Yes a <br /> a No <br /> D Permit application fees submitted? <br /> o Amount Receipt# ro��r� CGA1 <br /> � <br /> a ' <br /> ❑Reconciles with Real Property Lister Yes No Date: () <br /> If not,explain: <br /> J <br /> o <br /> Application' J <br /> - - rL�� Dcmea Reason for Denial: O <br /> Land Use: <br /> Date: <br />