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Fees(must accompany form): <br /> Burnett County Subdivision Permit Applicat on Subdivision Wo Survey: $50.00 <br /> Survey of Existing Parcel: $50.00/lot <br /> and/or Pre-Application Form Subdivision W Survev: 5200.00+$50.00/lot <br /> Owner: Ar�in � c? A-r,c_�c% Buyer: "Z <br /> Address: a�(fl�5 SSS Lci�<e Address: <br /> 0 <br /> Phone: (-�1P3) (v07- 5 3 b 3 Phone: <br /> 1 <br /> OriVinal Parcel Information <br /> o7-czc-l-40 -iU-oy- 5 o5-ca2- ciy0c0 <br /> Parcel ID#: 07-020-L-yo-ilo-o4-5 n5-cez-et 3acc; Section �j_1_Township�U�Range kJ <br /> O <br /> Original Description (or attach copy): PC.L i CSM V3 P lVo Le+ 2� <br /> PC L 2 CSt-1 V S P 19 7 (Tyi &t,✓ L, 2- <br /> 5 <br /> y �s- <br /> Current Zoning: Y�''`` Floodplain Wetlands Y/N: Lake/River Class: .� <br /> Name of Water Body: _t Cc A., t1 Le Shoreland Agement/SIPS Y/N: � <br /> `c C�?. .k re � <br /> Farmland Preservation Y/N: Managed Forestry Law Y/v: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: d1 <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: v <br /> Proposed access to public waters to be provided Yam: <br /> If yes, describe access: W <br /> Signature of Owner: Date: � �� <br /> �3 y <br /> nn 7 <br /> Signature of Owner: Date: <br /> z <br /> > Does parcel meet Zoning Requirements? Yes No AGe_ -7/Zs <br /> N ! � <br /> > Does parcel require a Szu-vey? Yes No Gk- A� 5�r3 <br /> °A > Permit application fees submitted? ❑ Amount S /0 O, ed Receipt# ^,z <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> 0 <br /> c If not,explain: <br /> 0 <br /> c <br /> Application Approved / enied Reason for Denial: <br /> Land Use: Date: Ka3zzo/? <br />