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Fees (must accompany form); <br />Burnett County Subdivision Permit Application SubdivisionNv/o Survey: $50.00 <br />Survey of Existing Parcel: $50.00/lot <br />and/or Pre -Application Form Subdivision w/ Survev: $200.00+$50.00/lul <br />Owner: bauid -+ A0 CPP VX IBuyer: <br />Address: a -A170 W� e r,y,0 5J—k PI -_ Address: <br />Phone: (4 S/ 6 33 - P22I Phone: <br />Ori incl Parcel Information <br />a - <br />Parcel ID #: 6'7—paO-c7-90—& 3,5'S D �r�Section 35 Townshie q0 Range J(o <br />Original Description (or attach copy): �u �_ CSJN 0 a <br />Current Zoning: R344� Floodplai Y/ : II // tiVetland Y/ Lak iver Class: <br />Name of Water Body: Cc-) v�v�o 15 0.,15 P__ Shoreland Agreement/SIPS <br />Farmland Preservation Y(N:) Managed Forestry Lam <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size: he_ a ex 1,4s <br />V'o O >1 e' 'o gw <br />Acres: 3 7. a. 9 <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 />Signature of Owner: <br />Signature of Owner: <br />➢ Does parcel meet Zoning Requirements? <br />D Does parcel require a Survey? <br />Date: <br />Date: <br />Yes No Q e I Z 1(%? <br />Yes No <br />e/ <br />➢ Permit applicalionfeessubmitted? ❑ Amount $ SD' Receipt # <br />❑ Reconciles with Real Property Lister Yes No Date: <br />If not, explain; <br />A <br />Land <br />Reason for Denia <br />bate: / <br />