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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: $10.00 <br /> and/or Pre-Application Form <br /> Subdivision wl Survey:$1 oo.00+$15.00)lot <br /> Owner: <br /> pQ� <br /> Address: <br /> I, IQ�W e1� IV Phone: (o- 7D ooz0-432 3 <br /> 02ga0- 0 3000 - 0'601 o Original Parcel Information <br /> o3zov -- 0 33�� 'I / <br /> Parcel Identification#: 026 -V ILI �'d ) Section 71 Township�Range �� W <br /> Original Description (or attach copy): S W VLIV.n / <br /> f <br /> 0 <br /> A <br /> a <br /> Current Zoning: /7 Z fib Floodplain Wetlands Y� ~ <br /> LaketRiver Classification: Name of Water Body: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: C S <br /> /1'1 <br /> Acres: 3� 1 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: -- -ILSLtJ_l Li �� e _ Sky IS <br /> a <br /> n,, q v <br /> Signature of Applicant: / , I Qh rZ mac. K2�Q�uy/S� Date: <br /> N ➢ Does parcel meet Zoning Requirements? Yes No <br /> 0 <br /> '- ➢ Does parcel require a Survey? Cly— No <br /> or°o <br /> ➢ Permit application fees submitted? ❑ Amount$ <br /> Receipt# 3 <br /> 'o <br /> e <br /> ❑Reconciles with Real Property Lister Yes No Date: a <br /> 6 O <br /> � o <br /> e If not,explain: q �S <br /> a SWI W W <br /> w a J J Jqq <br /> d O Oa , M <br /> W .,p <br /> Application Approve / Denied Reason for Denial n a a o 0 <br /> 00 <br /> o c 0 <br /> Land Use: Date: <br />