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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-A lication Form Subdivisiunw/o Survey: $10.00 <br /> PP Subdivision wl Survey5100.00+$15.00/lot <br /> Owner: Lon�it xe„} �11kr <br /> Address: 18333f- c . Rl t-1 <br /> ,J`vs'b�y (I,�s Jat$3ci Phone: 71 C-9". 13-].S e <br /> 11,T . a C/OC?� Orieinal Parcel Information <br /> Parcel Identification#: d, (n- 9Z00-0Z 300 Section Township Range&w <br /> Original Description (or attach copy): Imo} �� �4 od,� 4h(-,e L3) vSt(\Stnri• <br /> O <br /> I-a,kp Short �wtSion �� �Qllot� l rn�t afuyr�tna ao tla �� <br /> g �aY<o� ou ��In ti J a$�lee o� tle �1ea6Gti o� T�eds 1; <br /> ^ Current Zoning: e- i FloodplainWetlands Y/CL' S' <br /> 0 <br /> Lake/River Classification: #Ah Name of Water Body: <br /> U <br /> New Parcel Information � <br /> // <br /> Proposed New Legal Description and Parcel Size:,{U 1 cYFpp wt� le BfOdc {4^K1 `3)l <br /> 4,05445 kA't Skog 13(u 04 4pllct o in n� -4e wes � Mgsj �. <br /> � �lr}— <br /> 50 4e.�- t JAkCA. claa beco+ - oft$ A I.a- 1 d Igt r+Acres: o)(s� 1. 4-f I `r <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map require ents)17Z <br /> #h <br /> /A, T <br /> Proposed access to public road: 5,ec.or`cl &z., <br /> Signature of Applicant: 'L'Al ' Date: _]- i)- oL <br /> 1 <br /> ➢ Does parcel meet Zoning Requirements? Yes No �.. <br /> N <br /> e ➢ Does parcel require a Survey? Yes No <br /> as n <br /> D Permit application fees submitted? ❑ Amount SID, Receipt#96 a <br /> c <br /> e11 Reconciles with Real Property Lister Yes No Date: <br /> 6 <br /> If not, explain: <br /> 'e y <br /> Applicatio Approved / enied Reason for Denial: Al <br /> 04 Ad one Ae -- <br /> Land Use: L1S Date: -, o�p b <br />