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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: I 0.00 <br /> Survey of Existing Parcel: 1,50.00/lot <br /> and/or Pre Form Subdivision $200.00+SSO.00IIot <br /> Owner: &rrje 1 Lt/rVw1 Buyer: ro <br /> Address: Z� �� �I D Itu K Address: 3 <br /> .a 1 (/c..ts,h r �go .. <br /> Phone: 9I5 '- 3y 11 Phone: <br /> Original Parcel Informations / <br /> Parcel ID#: Section Z3 Township 7IAI Range 14 Vy� <br /> � <br /> t O <br /> Original Description(or attach copy): 1�1 w l/y 5 C /`� <br /> IN C&VAX gg ow <br /> ro <br /> 6^11e 1poyto arcrJ4 4-1b01 <br /> m Current Zoning: RKY - 1 Floodplain Y�) Wetlands Y6.) <br /> 0 <br /> Lake/River Classification: Name of Water Body: <br /> Shoreland Agreemt or SIPS Y iT _Farmland Preservation YX', Managed Forestry Law Y/6,__ <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: Z• g1 1 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: �� <br /> Proposed access to public waters to be provided Y/N �__ _ <br /> If yes,describe access: <br /> c Sign re of Owner: Y\1\ —Date:— <br /> iw � A, <br /> °Q Sig lure of Owner: Date: B <br /> v <br /> e <br /> ➢ Does parcel meet Zoning Requirements? C'` Yes No <br /> x� <br /> ➢ Does parcel require a Survey? 6y;' No <br /> a <br /> Permit applicatio ees supmitted. ❑ Amount$ a�' Receipt# I 13-70 <br /> mt. <br /> ❑ Reconciles with]eal Property Lister Yes No Date: <br /> y If not,explain: <br /> Application: Approved / Denied Reason for Denial: <br /> Date <br /> Land Use: '6 <br />