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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.001w <br /> �nn and/or Pre-Application Form Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner: T) ��le A <br /> Address: of %CLq ku'&Q <br /> 0 <br /> / Phone: 2 Sq—7e),Z 7 <br /> w <br /> X02$-9a�5 -6 //oo OrieinalParcel Information <br /> �� <br /> Parcel ID#: O a�'9�7� /6)12 ✓640 Section Township <br /> uYN41 Range <br /> Original Description(or attach copy): <br /> Posvl « -N6zi1j6.ex B 6>c L <br /> a : Wedand6Y N: _ <br /> Current Zoning-IF-D F►oodplai v& <br /> �Me <br /> /-oN Lk N La ! <br /> e Lake/River Classification: Name of Water Body: <br /> New Parcel Information S <br /> Proposed New Legal Description and Parcel Size: <br /> 17�j'TY1 � <br /> Acres: 95 � <br /> (If parcel is to be surveyed,provide preliminary map. See�attached for preliminary map requirements.) <br /> Proposed access to public road: L vG Ll /tom l'o <br /> rl <br /> Proposed access to public waters to be provided N1 : <br /> d <br /> m <br /> If yes,describe access: <br /> Signature of Owner: Date: <br /> ➢ Does parcel meet Zoning Requirements? Yes No p�g <br /> e <br /> ➢ Does parcel require a Survey? Yes No e <br /> 56D, bb Receipt# 107? <br /> g <br /> Permit application fees submitted? ❑ Amount$ e <br /> A <br /> a <br /> t ❑ Reconciles with Real Property Lister Yes No Date: p <br /> o � <br /> a <br /> qy If not,explain:CL <br /> o v St1 <br /> r <br /> I � O <br /> Applicatio Approved enied eason for Denial: - �jrGt�,lt <br /> Land Use: <br /> Date: <br />