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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form ubdiviionwiosurvey: ato.00 <br /> PPS <br /> ubdivisionw/Survey:S100.00+SIs.00/lot <br /> Owner: �Aty��+�� ..)Tr_2pl�hi�F U Q%rla <br /> Address: I,12. 1 ke RAt�ZQ,/� <br /> %A0*A%-0U-s, VI 5!!4% U'j-1 Phone: -71% 3QV 1T1(�(p <br /> Orl¢inal Parcel Information (//� U 1 <br /> Parcel Identification M (3Z%-f" VW-OI -SIO Section 30 Township 16 Range ' <br /> Original Description(or attach copy): <br /> rl <br /> a <br /> Current Zoning: Floodplain Y/N: N Wetlands Y/N: �( <br /> C <br /> Lake/River Classification: Name of Water Body: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: IO a <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) 1� <br /> Proposed access to public road: Ex t4=NQ QQ-W 4W&V 3 <br /> Proposed access to public waters to be provided Y/N: N <br /> If yes,describe access: <br /> A <br /> Signature of Owner: Date: <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> e 4 <br /> ➢ Does parcel require a Survey? Yes No <br /> //`` <br /> D Permit application fees submitted? El Amount Amount$Ab,� Receipt# g <br /> e <br /> �7 e <br /> m ❑Reconciles with Real Property Lister Yes No Date: <br /> 6 rJ <br /> �y If not,eaplain: ' <br /> o ) � <br /> , <br /> Application: Approved / Denied Reason for Denial: <br /> t1" <br /> Land Use: Date: <br />