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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Suhdiv'isionw/oSunec: $50.00 <br /> Sunny of Existing Parcel: 550.00/lot <br /> and/or Pre-Application Form Snhdivisionw/Sunev: S2oo.004550.0o/Im <br /> ;;77 / L <br /> Owner. fnrC�c �� ��f�r�� P�' �a!Mrr: (Qv\�kfvFirvklh)G11iLQ Moe V0S/1 ,4 .fl <br /> A <br /> Address: Address: 3YCI r= <br /> Fede;1�i Lc' -T_ sS/637 It�1 fe.x, r' tl VIIW3 0 <br /> LJl <br /> Phone: Phone: <br /> Orieinal Parcel Information <br /> Parcel ID#i: O7-03Y-..2-37- J&-a6-'1 nC/ GCC c /ILrY Section dlf Township,39,U Range <br /> Original Description (or attach copy): _I C L` / L <br /> A <br /> Current Zoning: Floodplain Y/N: X etlands Y/N: Ile, Lake/Riper Class: L� <br /> m Name of Water Body: Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N• - rb <br /> J <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: t' J Ib1 n CEJ 0 t-J I of SPM Pt.� <br /> Acres: 0.015- <br /> (if <br /> .CSS(If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: O <br /> m <br /> Proposed access to public waters to be provided Y/N: <br /> If yes, describe access: `v <br /> Signature of Owner: Date: – <br /> Signature of Owner: Date: <br /> 0 <br /> 3 <br /> i Does parc•e!meet Zoning Requirements" )'es Na <br /> c <br /> u <br /> � i Does pureel require a,Survey? Y'e.c No <br /> 00 'r Permit applic•alionfees.cubmiued? /Q(j\ .gmorou Q ZS�� � Receipt# <br /> r. ❑ Reconciles with Real Property Lister Yes No Date: <br /> m — UI <br /> CL If not,explain:_ _— <br /> 0 <br /> - U <br /> CL -- -- _ I <br /> Application: pproved Denied Reason for Denial: <br /> _ 0 <br /> Land Use: Date: <br />