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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 Pre-Application FormSubdivisionw/Survey: $200.00+s50.00not <br /> �XtSTIn$ ff Sint4eri�7T+is .4 <br /> C.--OwnerS eja hh D, N P-w j4 aLn -Bulgier. q <br /> Address: 1908 90A NP_LQS L-0.h&- Address: a`� loC Nolly L�tn� N, 3 <br /> R <br /> 1A AR ?Z[,,e I Q(yMLNtKI AA 4, S 5 4 0 <br /> Phone: 8 70 7 41 - L4 L 10 6 Phone.(76-3, 4_73 -I(a7Z. <br /> Oridual Parcel Information <br /> Parcel ID#: 29 S 9(D Section /3 Township q O Range J4) O <br /> Original Description(or attach copy): N� U Ory-�: o t,9 L./ a f TCS it <br /> r <br /> o Current Zoning: /Q <br /> Floodplain 1/N Wetlands Y& Lake/River Class: <br /> n Name of Water Body: Shoreland Agreement/SIPS <br /> o a' <br /> Farmland Preservation thiD Managed Forestry Law WZ2 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: Wc-,s+� 4 f 7a CS krief) EA3>1)54Ta (NeLij �) <br /> Q+r. - dk\1idedg(Qeds S1'tk er+h +a SCt-ki <br /> X46 % (-CC'. 5 U Acres: <br /> (If parcel is to be surveyed,provide Preliminary map. See attached for preliminary map requirements.) <br /> GX,istt0q �jJ t— 1 m_ <br /> Proposed access to public road: We S4 A.Cc e SS—T0�n Stvi Lai RCI C/�S� kQe3-S --cry d <br /> O P4 P „C', <br /> Proposed access to public waters to be provided Y/N: t--,-- }tr j <br /> 5 <br /> �o99+n9 Rcl rurs /J' a <br /> If yes,describe access: Fu(( (en j hsL {)ro <br /> G Ire <br /> Signature of Owner: Date: 0l <br /> i' �' �lo <br /> Signature of Owner:' G '� Date: S <br /> e <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> at <br /> o ➢ Does parcel require a Survey? Yes No <br /> 0 <br /> 0 <br /> 00 ➢ Permit application fees submitted? Amount$ ��m C.l J Receipt# <br /> r 11 Reconciles with Real Property Lister Yes No Date: <br /> m <br /> 0 <br /> If not,explain: <br /> A <br /> 0 <br /> R <br /> a <br /> N <br /> Applicatio Approved / nied Reason for Denial: <br /> z,4 os s� <br /> Land Use: C� /Z z0 Date: <br /> BURNETT COUNTY <br /> ZONING <br />