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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: 550.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> ,I I and,/or Prre Ap/plication Form Subdivision wlSurvev: S: S500011 <br /> Owner: �L`^`'"--T^-�'� � Buyer: .o <br /> Address: 50 „t aa- 1l6 Address: 3 <br /> Phone: 1/6 _1SKJI2_ / LI7 / Phone: <br /> q 3 0- 0416W Original Parcel Information J <br /> Oto- q336_()9_7,66 36 yon/ <br /> Parcel ID#: Section Township Range <br /> 07-0 <br /> 3 z�o2— o <br /> Original Description(or attach copy): <br /> LaT i CS0 V-2-0 P/ 30 5Gt1 5E <br /> _ t 15 �� <br /> Lal Chir» V 20 :5Z- - :�5E S a-) A <br /> -2p Floodplain hu Wetland <br /> Current Zoning: � sdk <br /> POLake/River Classification: Abet—� Name of Water Body: IO Ano At <br /> . .S <br /> Shoreland Agreemt or SIPS Y T; _Farmland Preservation Y/&_Managed Forestry Law Y& is, <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: �(° <br /> redly, s,-m of Ley eV Zap /32- 3-3 <br /> 11J� �j/Yl V 20 { /_'L/) Acres: L/ 7.// <br /> 7 c 5m Vzco P T30- i 3--3 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C t1.1 /Cd 7+ �G <br /> Proposed access to public waters to be provided yo <br /> - <br /> If ves,describe access: <br /> c Signature of Owner: Date: <br /> 0 <br /> °Q Signature of Owner: Date: 3 <br /> ➢ Does parcel meet Zoning Requirements? Yes ' No ole v op <br /> d ➢ Does parcel require a Survey? Yes No 0 0 <br /> a <br /> D Permit application fees submitted? ❑ Amount$�00 O Receipt# C <br /> o ww <br /> w <br /> a ❑ Reconciles with Real Property Lister Yes No Date: a <br /> 000 <br /> If not,explain: ao <br /> 00 <br /> �Gc <br /> Application: Approved / Denied Reason for Denial: <br /> Land Use: Date: <br />