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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or��C Pre-Application Form Subdivision w/Survev: $200.00+S50.00/lot <br /> Owner. ,� i IP Buyer: <br /> er: <br /> Address: 2 9 / / <br /> � �1 t r)a Address: �� i Ce/r( L n <br /> �6 1 5_3 P <br /> 0 <br /> �j 7/s � 8 �ss <br /> Phone: �[�� [ � '� 3 2�3 Phone: .r <br /> Orizinal Parcel Information <br /> p� as -�_, CA <br /> Parcel ID#: —®ZQ � -��-�/ -z Section TownshiP_�{(��1i Ranget <br /> Original Description(or attach copy): f 2- A] N 11/ LY6 <br /> Current Zoning: Floodplain Y/N:�_Wetlands Y/N: _Lake/River Class: 1 V <br /> Name of Water Body: N (It <br /> _ Shoreland Agreement/SIPS Y/N: <br /> Farmland Preservation Y/N: Managed Forestry Law Y/N: IV <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: 44. 4 v 1 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C7 <br /> m <br /> Proposed access to public waters to be provided Y/N: fD <br /> If yes,describe access: <br /> l� <br /> Signature of Owner: Date: <br /> Signature of Owner: �! /!1 C) iwt a," / Date: -2- _ o <br /> 3 <br /> e <br /> N ➢ Does parcel meet Zoning Requirements? Yes No <br /> ➢ Does parcel require a Survey? Yes No <br /> w <br /> o-°a• �/y W <br /> Permit application fees submitted? ❑ Amount$ 00 Receipt# <br /> !r <br /> r. ❑Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> o � T <br /> c. <br /> A <br /> W <br /> Application: A proved / Denied Reason for Denial: p <br /> u H o e4 1( 1O <br /> Land Use: Date: l �2� <br />