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Fees(must accompany forni): <br /> Burnett County Subdivision Permit Application Subdivision,v/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application Form Subdivision,Y/Survev: $200.00+$50.00/lot <br /> Owner: baml� "t c ALan i) Buyer: � <br /> Address: 10591 kg�u1d C%rO Z N Address: �• <br /> z <br /> G <br /> Phone: Phone: c <br /> Original Parcel Information ,Q <br /> oo-cog-D-40-11-11-3 M -000- Now <br /> Parcel ID#: 07_��js _ -']p-l1-11 3 a4-bO0 01,300.'j Section Township ya Range _w <br /> Original Description(or attach copy): Lo� cS Vq s Png� L<6-s t&j <br /> Current Zoning: ►1�� fFloodplain YN:_�Wetlands Y/v: _Lake/River Class: <br /> Name of Water Body:_n 1 a Shoreland Agreement/SIPS YIN: Yl <br /> c <br /> n <br /> Farmland Preservation Y/v: VA Managed Forestry Law Y/v: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: A I c, eM 1�eU►SI►' <br /> Acres: �5 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: e_> 6 rjV, p <br /> T <br /> Proposed access to public waters to be provided Y/v: Ij1 <br /> If yes, describe access: <br /> Signature of Owner- <br /> Date: <br /> Signature of Owner: L Date: <br /> -o <br /> c <br /> > Does parcel meet Zoning Requirements? Yes No -7 Z 70 9 <br /> z <br /> Does parcel require a Survey? Yes No°Q Permit application fees submitted? ❑ Amount$ 1 Receipt# <br /> rF <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> n <br /> 0 <br /> G <br /> y <br /> Applicatio :,�Appjroved/ Denie/d Reason for Denial: ��1122 <br /> � of3 624N �N2.q �bl� l�odl-con rw�J ✓► ✓4 a <br /> Land Use: 7i`� LDl Date: <br />