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trees (must accompany form): <br />Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br />and/or Pre -Application Form Survey of lixisting Parcel: 550.00Aot <br />_ t <br />pp Subdivision w1 Survev: 5200.00 + $50 0011ot <br />Owner: <br />Address:-Q(=,,Address: <br />Phone: tom` { ti t177 G-' <br />Phone: <br />L,3-_CV0- j Original Parcel Information <br />c 113M7) <br />Parcel ID#:oiiy�t> <br />1o3fr-I w3-000" i�-�-s>s-cul-rt�CE Sections Township y/ Range l <br />Original Description (or attach copy): 3 :f -5M <br />65M V20 P8,57(.0 7 3' -A 1 - - 6UJ VLJ 4,f , 3 <br />i <br />C Srn V 10 V"2j5_ C (14 ! * N1 - _f _ /0 t �2 C:6 r" v i1� p'S * bml'�. f Z',Li l 11 y pt'?y <br />;" Current Zoning: EI !Flo dplain 1�IN�_ Wetlands N: ` LakelRiver Class: <br />Name of Water Body: Shoreland Agreement/SIPS /N <br />Farmland Preservation )MI' Managed Forestry Law 1(/N: <br />New arcelinformation 1 <br />Proposed New Legal Description and Parcel Size: AJ LW L -D 1,U le 3 1 <br />�Q S0 1' S <br />_ <br />Acres: / 3 • / <br />(If parcel is to be surveyed, provide preliminary map. See attached for preliminary trap requirements.) <br />Proposed access to public road Z�yt i S 4 i , eR <br />Proposed access to public waters to be provided..1�N.� <br />If yes, describe acc!� <br />-Agnatute otOwners; �` L-- <br />Signature of Owner: <br />Does parcel meet Zoning Requirements? -- Yes �:'vo <br />Date-, <br />'r Does parcel require a Survey? Yes NO <br />Permit application fees submitted? 0 Amount $ (p ©Or Receipt 4 <br />13 Reconciles with Real Property Lister Yes No Date: <br />If not, explain: <br />Land Use: <br />Approved /)Denied Reason for <br />Z047 Date -r r V.,WUNTY <br />�'[> uwr0 <br />W <br />0 <br />V <br />w <br />n <br />�e <br />