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Burnett County Subdivision Permit Application Fees(must accompanyform): <br /> and/or Pre-A lication Form <br /> Subdivision w/o Survey: $10.00 <br /> AA Subdivision w/Survey:$100.00+$15.(10/lot <br /> Owner: Q �y�,-� &,//6/61'n ,, <br /> Address: 5 /�'�-rl NQ 1'/v 6 0"0 S RD <br /> Phone: <br /> Clt <br /> 36G q qqG 657-- <br /> � OriiJginal Parcel Information U ./ 6 <br /> Parcel Identification 657--5�7 Qection��Township 7//V Range <br /> Original Description(or attach copy): �C 5E IVE O <br /> f <br /> e <br /> a <br /> m Current Zoning: ,`2 q'pZ'� -Floodplain Y/N: Wetlands YIN: / <br /> Lake/River Classification: Name of Water Body: C- C <br /> S <br /> New Parcel Information <br /> CProposed New Legal Description and Parcel Size: �y+ � <br /> Acres: � . 13 <br /> (If parcel is to be surveyed,provide preliminary ma/p./See attached <br /> �for <br /> ,preliminary map requirements.) <br /> Proposed access to public road: <br /> v <br /> m <br /> Signature of Applicant: Date: <br /> N ➢ Does parcel meet Zoning Requirements? Yes No Q) <br /> 0 <br /> ➢ Does parcel require a Survey? Yes No A <br /> 0 <br /> ➢ Permit application fees submitted? ❑ Amount$ 7�0- Receipt <br /> e <br /> m <br /> � ❑Reconciles with Real Property Lister Yes No Date: � <br /> a <br /> If not,explain: <br /> m (T <br /> R5 <br /> SU <br /> s <br /> Application: Approved / Decried Reason for Denial: L-Y'(S/�nom, 3/\ <br /> Land Use: Date: <br />