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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: $10-00 <br /> and/or Pre-Application Form Subdivision w/Survey:5100.00+515.00/lot <br /> Owner: 1rz.tt L 2]anA nn 1 Q L SB iQ <br /> n <br /> Address: 2`I2>'10 <br /> Poo E2 , Z 5�8 I Phone: &35- qS 9 1 o <br /> r <br /> Original Parcel Information \ <br /> Parcel Identification#: 028- 4tzto-o Z-Zic Section ZD Township Range l�1 <br /> Original Description(or attach copy): t O,=r O F G L • .-1 O <br /> pGt �i J �Et_p V o t_ tall <br /> EtkSEMErIT SJEe� 1 S VoL X770 . �AC,E 3S7 <br /> 'e <br /> o Current Zoning: Zi Floodplain Y49 Wetlands Y(l�c' <br /> Lake/River Classification: Ltk e2 ?� Name of Water Body: M uy <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 2 I—O T GeAmt`l F=1 E 17 ...SV si:V <br /> WAP Lo-r V-0 Ft= W A-rEa1 = 9 . ro S Are-imtSS Lo-[ Z o Irl <br /> -(o i a.L- <br /> U c, LA(Ga S. 03 4L2EGi . Acres: t %.-I .4r_�V_s <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: F1Z1 MATE <br /> t7 <br /> m <br /> Signature of Applicant: /tom. Date: 10 - ZO -0(,o <br /> CJ.1 <br /> ➢ Does parcel meet Zoning Requirement . Yes No <br /> o <br /> ➢ Does parcel require a Survey? Yes No <br /> oa <br /> 0 <br /> Permit application fees submitted? mount$ 13 D•D O Receipt # '3o? a <br /> C <br /> A <br /> 1 <br /> r a <br /> ❑ Reconciles with Real Property Lister Yes No Date: o <br /> RIf not,explain: <br /> o � <br /> 6 Y <br /> M <br /> 04 <br /> Y <br /> Applicati Approved / nied Reason for Denial: At <br /> o <br /> Land Use: Date: AU <br />