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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 Form or Map Review Form Subdivision w/Survey: $200.00+$50.00/lot <br /> r 7 <br /> Owner: Aar'or. 14_5 Buyer: <br /> �t y I� T <br /> Address: <br /> 15(02_ "Id.I a Q 1 beir5,..,I\ Address: <br /> Lei.144.kilt\It- inN1 5501 <br /> Phone: ( l77 4-,I--55R 1 Phone: <br /> Original Parcel Information t <br /> o5-007-01 2-°°1:3 ...&Parcel ID#: 01-OM-'y-40-14-lq * <br /> -5 Section i q Township 40 Range ' <br /> B Description(orcopy): Lel A- l c�Pi -a l S5 0 <br /> Original attach <br /> m <br /> 1 <br /> Current Zoning: Floodplain YIN: Wetlands Y/N: Lake/River Class: <br /> ,' Name of Water Body: Shoreland Agreement/SIPS Y/N: J� <br /> v. <br /> =.: <br /> Farmland Preservation YIN: Managed Forestry Law YIN: <br /> New ParcelInformation <br /> 11 RI <br /> Proposed New Legal Description and Parcel Size: ADii k.bre.oA L_zs.r A C ko A 46 <br /> tai 4,,,e-ea , C.,..‹,try-) A.e, chow, 01 2- o s Aat.&. <br /> Acres: S$ <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) m <br /> rt <br /> Proposed access to public road: e stry\R"N 6,..c. 4.6,4 s4_4_ <br /> Proposed access to public waters to be provided YIN: <br /> If yes,describe access: <br /> >/6-amu ++:: <br /> Signature of Owner;/4"--- Date: <br /> 55 <br /> Signature of Owner: Date: <br /> > Does parcel meet Zoning Requirements? Yes No Gki l'1" 1110 <br /> V ). Does parcel require a Survey? Yes No <br /> 0 <br /> To <br /> a )=- Permit application fees submitted? 0 Amount$ S0 �r Receipt# <br /> 0 Reconciles with Real Property Lister 411100 No Date: if,II ZIP/Z.0 2./ <br /> a <br /> a If not,explain: <br /> a <br /> O <br /> �S <br /> e Applicatio. •pproved / D..ied Reason for Denial: <br /> Lan e: Date: <br /> (92.771-/V7 Z( <br />