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Fees(must accompany fmmy <br /> Burnett County Subdivision Permit Application Subdimsionw/oSurvey: :50.00 <br /> Survey of Existing Parcel: 550.004ot <br /> /hand/or Pre-Application Form /7 Subbdiviision w/Survee, 1200.00+I50.011/lot <br /> Owner: OhN N E L 5�� Boy, OA 10 E,1 GEL 11 h7eDT <br /> Address: 2V11 I Po "'p dress: <br /> Phone: Phone: U'-tA� 1 / flf� ✓�� I� <br /> 4T00�-2-38-14-U2-.SOri incl Parcel Information 6J <br /> -D(1-OI$IDG �y�/ L/ <br /> Parcel to#:09'�`�'1'3Y'ly'ODS IC2-Zr60-OIIOfbQction -2— Township3brV Range /yW O <br /> Original Description (or attach copy): LOT /7 D F V -c- PL <br /> > (QTS i X67 f of CS) n ;ljo 1298 VIZ 0716- Zl ) J <br /> 9 <br /> G. L. 1 <br /> Current Zoning: RR I �s Floodplait�' V: (�Welhmd Ys�Yi : <br /> Lake/River Classification: d— Name of Water Body: <br /> New Parcel Information <br /> ,/ <br /> Proposed New Legal Description and Parcel Size: osq LOT e.7�� V tS <br /> a <br /> L <br /> Acres: '1l <br /> �l <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) t <br /> Proposed access to public road: r0 yca.e.e.t.2_ e.. f�,Owc-C <br /> -- C <br /> Proposed access to public waters to be provided <br /> If yes, describe access: C, <br /> c Signature of Owner: — Date: P✓ c <br /> e � <br /> — I <br /> °O Signature of Owner: Date; k <br /> a <br /> r Doesparce(meet Zoning Requirements? s�— No Q& r �-, J <br /> ➢ Does parcel require a Survey? Lyes No s <br /> V S <br /> c I <br /> 7 Permit applicalionfees submitted? Amount Receipt# vl q <br /> c <br /> ❑ Reconciles with Real Property Lister Yes No Dale: <br /> If not,explain: W <br /> G <br /> Q <br /> Application: rov Denied Reason for Denial: (!1 <br /> I <br /> Land Use: Date: <br /> [/ v <br />