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Fees (must accompany form): <br />Burnett'County Subdivision F'er'n Application Subdivision W/o Survey: $50.00 <br />and/orP@- �1@fLt1UI1 (iipl Survey of ExistingParcek SSo,00/iot <br />Pp Subdivision w/ Survev: 3200.00+ s50.00ilut <br />Owner: SVrVt Nr1,j';? Buyer: <br />Address -_k 24ep Address: 271 11-CA6 aoV" i?P <br />w4jlt- w, s4Ru _ <br />Phone: q-1�2' is x'903 Phone: <br />a?- Oto, Z a40-&-23 Or! --:,Ina] Parcel Information <br />Pa reel ID#: $ DS » Dt}7 -« p/gpao } J*%VbV -) Section Township Range A; <br />Original Description (or attach copy): Lt -Is 11 4 1Z - %. o 6,1 .[,_ 17 <br />Current Zoning:(+^�Floodplsi6N: tiVetlands Y I alceiRlver Class: <br />Nance of Water Body:___'7A #,lam 4449 Shoreland Agreement/SIPS Y/N; 7 <br />Farmland Preservation Y(� ...Managed Irorestry Late <br />New Parcel Information <br />Proposed New Legal Description and Parcel Size; Ne W ��'t_;.ct -Or C,jej <br />tiKr - <br />Acres: �r+b <br />(If parcel is to be surveyed, provide preliminary map, See attached for preliminary reap requirements.) <br />Proposed access to public road: <br />Proposed access to public waters to be provider: <br />If yes, describe access: <br />Signa ture of Owner: <br />Signature of Owner; <br />> Does parcel meet ZoAldg Requirements? <br />Does parcel require tt Survey? <br />Pertnitapplicationfei+s.rttboilited? 0 <br />Date: --/4 - Zolk <br />Date: __% #fin_/J� <br />Yes 1Vo C*, 4A /S' <br />Yes No <br />Amount J_ 30e, Receipt # <br />CI Reconciles with Real Property Lister Yes No Date: <br />If not, explain:, <br />Land <br />Reason for Denial; <br />Date: <br />r <br />0 <br />S <br />