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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: S 10.00 <br /> and//o�-r- Pre-Application Form Subdivision w/Survey: S25.00+s5.00not <br /> Owner: �66JC�1Al �21C I 111� <br /> Address: 0 y� PlL2 K / ,� p <br /> bGl/►1 fyu�t �t; �,v I `/g U Phone: <br /> Original Parcel Information A <br /> 2-NO-17--.�<_D 62700 �� WA/ Range 17W 3 <br /> Parcel Identification#: Section Township g z <br /> Original Description (or attach copy): L' 3 V3 ,>< �� .21- c <br /> Zd 119 3Z 8 3`I `? V31 <br /> z 3-7,7 <br /> J <br /> 0 <br /> Current Zoning: FloodplainOY N: of 1.4144- Wetlands�& <br /> �• Lake/River Classification: I Name of Water Body: ► 6 Yl.11oc✓ LJl k-r <br /> m <br /> New Parcel Information <br /> A\ <br /> Proposed New Legal Description and Parcel Size: 6 <br /> 3 Lor csr�l Lot l rst-A V /17 P9.) _ 93 . <br /> Acres: /0 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: rA't"h GVty e,t.I/ d4� �t <br /> Proposed access to public waters to be provided Y/N: Z L q4,, L.f3 8e o It L f A-ata <br /> A <br /> If yes,describe access: <br /> ➢ Does parcel meet Zoning Requirements? CiO No <br /> N o <br /> ➢ Does parcel require a Survey? Yes No c <br /> v'og <br /> ➢ Permit application fees submitted? Amount S w Receipt# T Q e <br /> " A <br /> x <br /> Reconciles With Real Property Lister No Date: <br /> es <br /> a W <br /> If n not,explain: " <br /> o , <br /> Application: Approved Denied Reason for Denial: <br /> ..:: v. tvµ x r t =•R±y x, ' r' ''�S L"'/ `�'.'! '}r^" ''a4, 'la ,fib <br /> Land Use: Date ' <br /> vlshoos �`- <br /> aa M. t ry e <br /> '� r k ¢F9 i7 5y Y <br />