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Burnett County Subdivision Permit Application Fen(mug wxmipaayfDrM). <br /> Subdivision w/o Survey: $10.00 <br /> and/or Pre-Application Form SuMvisim w/SurW.$100.00+$13.00ft <br /> Owner. v.2 I <br /> Address: 1 /7,�, � <br /> �yp/ o <br /> l /Vt ' Phone. <br /> 2 UaAMAA L�WjV.2,' 7 <br /> Oridoal Parcel Information ��v0 <br /> Parcel Identification k QI g', ,V-Pqj 0 Section 3y Township , Range f'bVV p <br /> Original Description(or attach copy): /V <br /> w <br /> Current niog: Floodplain Y Y: _ Wetlands YQ Z <br /> 9 <br /> Lake/River kation: —f Name of Water Body: <br /> r <br /> e <br /> w <br /> New Parcel Information 4 <br /> CLc,ts Ll <br /> Proposed New I.egd Description and Parcel Sim: / q <br /> -- Acres: <br /> a <br /> (If parcel b to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: p, /jam ✓.�/ <br /> Proposed access to public waters to be provided S <br /> If yes,describe access: <br /> U1 <br /> O <br /> i Does parcel meet Zoning Requirements? Yes No <br /> n <br /> D Does parcel require a Survey? Yes No e <br /> m ➢ Permit application fees submitted? Amounts H5 DO Receipt N csf a H 1 <br /> 0 <br /> ❑ Reconciles With Real Property Lister Yes No Date: °a <br /> O � <br /> If not,explain: w�W <br /> 0 <br /> 41 <br /> Application Apptovad / Hied Reason for Denial: <br /> 0 <br /> 0 <br /> Land Use: <br /> Date: /.2'Y—a3 <br /> v1E/M <br />