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Burnett County Subdivision Permit Application Eeemu., accompnyformy <br /> and/or Pre-A lication Form nw/o Su Vey: $10.00 <br /> Pp n w/Sur ey:S100.00+515.00/lot <br /> Owner: <br /> Address: <br /> 3 <br /> &2 WeCtDO 1i 5 / //A 6�1) Phone: o <br /> �tf <br /> 62& &312-04/0 Q2o_y3,z Ori inalParcelInformation `Q <br /> /1 <br /> Parcel Identification M d?0-q3/2,-Q 9906Section /1-13 TownshipRange <br /> Original Description(or attach copy): G/-. y Oct��w` /Z G. L. /3 0 <br /> 1AX C5m V / 9 <br /> > , <br /> Current Zoning: 11?2 Floodplainl: Wetlandstl: <br /> e <br /> Lake/River Classification: &4155 3 Name of Water Body: 6c-C)O/ceQ <br /> New Parcel Information �- <br /> Proposed New Legal Description and Parcel Size: (/� <br /> r�)'1 <br /> Acres: Y-35 t <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Signature of Applicant: _ ... Date• <br /> 8/ los <br /> C>,1 <br /> J <br /> ➢ Does parcel meet Zoning Requirement Yes No <br /> o � <br /> ➢ Does parcel require a Survey? Yes No \ <br /> n <br /> ➢ Permit application fees submitted? ❑ Amount$�DJ g _Receipt# 3 9 <br /> e <br /> m <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> CL <br /> c o 00 <br /> If O not,explain: o b0 <br /> o <br /> y W LSU'W <br /> W `NN�1 <br /> r i I <br /> + SNR) <br /> Applicatio : Approved / enied Reason for Denial: o q <br /> o coo <br /> Land Use: Date: �l <br />