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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: 5200.00+$50.00/lot <br /> -I/« Err-frF <br /> Owner: At/lrE� .TAGI�Smi�/l��uA�/7 J/4tX"Buyer: .o <br /> ro <br /> z <br /> Address: 317/02 STi97f It '0 3.- Address: sem' 'E 9 <br /> Phone: 7/S GSCe- 3¢/7 Phone: jr / 4 <br /> Original Parcel Information <br /> Parcel ID#: p-7 _ 03 Z - Z - 4/ -/>'-ps-¢ Section ,S Township ¢/ Range /S_ <br /> Original Description(or attach copy): E %z of /��� '1¢ aF SE %t S S o <br /> H q <br /> 7- <br /> Current <br /> Current Zoning: �� �' Floodplain Y/N: P, WetlandslN: Lake/River Class: -- 4 <br /> ,a Name of Water Body: Shoreland Agreement/SIPS Y/N: (� <br /> 9 / <br /> m Farmland Preservation Y/N: /-41 Managed Forestry Law Y/N: <br /> New Parcel Information II I <br /> Proposed New Legal Description and Parcel Size: �h- <br /> / <br /> Acres: <br /> n <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> �S <br /> Proposed access to public road: Kis7/ /� EASEr/ E /5- mb W <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> J <br /> Signature of Owner: Date: CJ <br /> I <br /> Signature of Owner: Date: 3 <br /> 0 <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> s 3 <br /> ➢ Does parcel require a Survey? Yes No I <br /> D Permit application fees submitted? ❑ Amount$ J W d Receipt# W <br /> ❑ Reconciles with Real Property Lister Yes No Date: (� <br /> m <br /> e <br /> if not,explain: <br /> o t <br /> a (7 <br /> Application: Approved / Denied Reason for Denial: �1 <br /> C <br /> Land Use: Date: <br />