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Nov . 18 . 2065 3 :41PM GREENDOG INC No - 1634 P , 2 <br /> Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: 510.00 <br /> and/or Pre-Application Form i 1Subdivision w/Survey:$100.00+$15.00/lot <br /> Owner: /`tel r r-O r 1e S liL..QX <br /> Address: / <br /> I� 1 til k.Q a an rrQL� ! l 1 �� I G Phone: L old - <br /> v <br /> Orieinal Parcel <br /> Information <br /> Parcel Identification k: �� -G C CI'OI 'Section _Township Range L o <br /> Original Description(or attach copy): =C C-_ " --j k)L /_ MC)04 (� <br /> '76 / r; en � Ck. c J <br /> y Current Zoning: Floodplain Y/N: Wetlands Y/N: <br /> v_ Lake/River Classification: <br /> Name of Water Body: <br /> d <br /> }� <br /> New Parcel Information nn I <br /> Proposed New Legal Description and Parcel Size: ��9 { X -7b <br /> _ 1 0 <br /> Acres: - <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> IV <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: C� <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N el <br /> ➢ Does parcel require a Survey? Yes '_"No- g <br /> w e <br /> e <br /> ➢ Permit application fees submitted? O Amount$ Receipt H <br /> ac <br /> r <br /> O Reconciles With Real Property Liste Xe No Date: <br /> C6 <br /> If not,explain: <br /> e � <br /> 6 <br /> J) <br /> I L Q) <br /> ved Reason for Denial: _��)Y 11_re4V175 < <br /> Th <br /> Land Use: / O <br /> Date: <br /> 2/16/2 <br />