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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Sul vey: 550.00 <br /> Survey of Existing Pareel: S51t CellOC <br /> ani ltor Pre-Application Form Subdivision wi Survey: S200.Q -S50.00/lot <br /> Owner: A.e. Dan i e /son / / )I1( Buyer: et <br /> a a 779 & ) Rd M R <br /> Address: Address: <br /> &ranbWi I ltd. .5 tig/o c <br /> Ga , <br /> Phone: Q n e05- % 7- Q / gat Phone: <br /> Oritinal Parcel Information p <br /> Parcel ID#: •a X ) p .32.Cp(() Section' }I35Township ? ) Rainge 1 <br /> Original Description(or attach copy): �c c . A �5`) )( <br /> 1 <br /> .z Current Zoning: NL CRL- Floodplain Y/N: ki Wetlands Y/N: y Lake/River Classy ' <br /> m ., Name of Water Body: Shoreland Agreement/SIPS Y/N: d <br /> F.,- <br /> Farmland;Preservation Y/N: Managed Forestry Law YIN: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: Le •" . ck,A & ( : v '+1tc 4 <br /> ( , X1'1 * n <br /> e- pe lid i fV C.SE 4 Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: ae„,,,,.._ , '�1 Q <br /> ,.„ <br /> �V <br /> Proposed access to public waters to be provided IN; �._ <br /> if yes,.describe access: '� <br /> N <br /> - _ — ___ _ _ - _ . / / /--I-` . " Date; 0 <br /> Sig natu'e of Owner: -J A A �_ _ 6 cy <br /> N <br /> "7 n <br /> Signature of'Owner: Date: <br /> g <br /> Cj <br /> ;r t:Does parcel meet Zoning Requirements? Yes No //Z/ <br /> ➢ Does parcel require a Surrey? Yes No w <br /> ami �j <br /> 0° > Permit application fees submitted? 12 Amount$ 300 Receipt# d` <br /> cr <br /> C., ❑ <br /> Reconciles with,Real Property Lister Yes No Date: Co <br /> m <br /> a If not,explain: <br /> 0 <br /> et <br /> et <br /> 0 <br /> a <br /> -40 <br /> Application: Approved enied Reason for Denial; <br /> Land Use: 04111111111. - I/ 7 a0Z.O Date: <br />