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Burnett County Subdivision Permit Application r Imast accnmpam mmp: <br /> Subdivision W/oSarvey: $10.00 <br /> and/or Pre-Application Form SanaiNisim"/Sur,cv$1100.00+$1s.lxmm <br /> Owner: if eAl/✓('g � /d� � /"/It j/&02 .LC &.=zx Ll <br /> Address: G70J G " 4 /cF l7 <br /> ,e <br /> 4a <br /> �h n 55/lZ a8zn� ms( o <br /> 46zo- gm-63.300 Original Parcel Information <br /> OZD- yq�f{ Qn#: / Q <br /> arcel Idefifification#: �t7�4" 573/,S'-J 350 Section/3 Township /df1l Range l/o IrV <br /> Original Description(or attach copy); � I�4 N Uj fw/ 5 (1-1 /Nl C <br /> g 71u5 � 2 npr o Ld-1-3 '�W <br /> o-/kl <br /> Current Zoning: till > Floodplain(9N: Wetland(- N: <br /> Lake/River Classification: UA" 117- Name of Water Body: (4. w y <br /> Y <br /> New Parcel Information Pa <br /> A <br /> Proposed New Legal Description and Parcel Sim: c6f)-) - t U I $-I dye 3 � <br /> Acres: (p . I U <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Gocl- a n f'62d — L[N1t mt( rL Aamd <br /> Signature of Applicant: ",Jhrµtyt Date: 7 /' /' <br /> J <br /> ° ➢ Onee parcel meet Zoning Requirenrent0 Yes � Na vy <br /> Y Does parcel require a Survey? Yes No <br /> w 1 <br /> ➢ Permit application fees submitted? ❑ Amount$5l�' Oy Receipt# <br /> e <br /> � v Reconciles with Real Property Lister Yes No Date: a o <br /> a <br /> If not,explain: <br /> 3 (,a <br /> o , <br /> WWF <br /> Applicatio Approved / enied Reason for Denial: W <br /> �r. W <br /> 00 0 <br /> C C 0 <br /> Land Use: Date: <br />