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Fees(must sccampnny forml: <br /> Burnett County Subdivision Permit Application Subdiviswim /a Survey: $50.00 <br /> and/or Pre-A lication Form Survey of Existing Per 1: $50.00aoi <br /> PP Subdivision w/Surwv: S200.004 S$0.00A, <br /> Owner: DhAl LRlAlE56Al „m OAViO E/16ELll*W7— <br /> Address: 2 A G�p�jdress: 2"1&0 �� ZA4 xl{/ <br /> -Wi 5q8 <br /> Phone: 1�J yb g' 7a1.3 Phone: _ �' -Q-Q,f. I A/ 5C 113 <br /> 07-00g""Z'�+)S'iY-02-$�riyfinal Parcel Information <br /> �9-0ll-016100 <br /> Parcel ctlon .2- TowasAlp36p <br /> N Range /y4/ O <br /> Original Description(or attach copy): /'7 o F 7ix-e. PL(lT Z /4 //ej1.¢ <br /> 41 <br /> 6F CSm 7J0 129 { VIZ p216- 21 ) <br /> 9 <br /> RRI <br /> Current Zoning: Flaodplei(�: n�Wedaa�; �.oLkA_ <br /> Lake/River Classifications 02-- Name of Water Body: a L&A-9— <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel She: a<oLO T C61n <br /> Acres: 1•�rJ i <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements,) <br /> Proposed access to public road: PO c)0,1p.-s.tR, <br /> Proposed access to public waters to be provided _ tv <br /> If yes, describe access: <br /> c Signature of Owner: Dole: <br /> o <br /> k/ , <br /> Signature of Owner: Date: Lb-�Y-13 e <br /> 3 <br /> 9 <br /> D Doespaeel meet Zoning Requirements? Yes No <br /> D Doesparce(requirea Survey? Yes No <br /> c <br /> eD Permil app/icullon fees submllsed? 0 Amount$ Recelpr P <br /> u ❑Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: <br /> Application: Approved / Denied Reason for Denial: <br /> Land Use: Date: <br />