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i <br /> Burnett County Subdivision Permit ApplicationL'u'b'd <br /> t accompany form): <br /> nw/oSurvey: SI0.00and/or Pree-ApplicationForm a wi survey:sloo.00+sls.00nol <br /> Owner: �QMt,v. QEF N E ( rel U �Jf1 J�y(p) <br /> Address: <br /> w <br /> �E9lcci FyJ\ Phone: p <br /> �_u <br /> Orieinal Parcel Information <br /> o28 -Y -02-3om p % Range <br /> Parcel Identification#: ��tt- �,Z_vee Sectio/n \ Townshi <br /> Original Description(or attach copy): tC 5 VV G 5 <br /> 0 <br /> e <br /> n <br /> Current Zoning: lec) - 23 Floodplai Yl/N: Wetlan g <br /> Lake/River Classification: Name of Water Body: <br /> New Parcel Information to <br /> Proposed New Legal Description and Parcel Size: <br /> Acres 77 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary in ip requirements.) <br /> Proposedaccess to public road: <br /> c <br /> Signaturmof Owner: Date: ^. <br /> Iv2v�ye� //�/hrr Gy® � 1716 — <br /> QJ <br /> Does parcel meet Zoning Requiremes? Yes No <br /> N <br /> P, Does parcel require a Survev? No <br /> 0 <br /> Permit application fees submitted? ❑ Amount S U Rect ipt# <br /> e <br /> I i <br /> � <br /> El Reconciles with Real Property Lister Yes No Date: <br /> CL u) v <br /> A00 0Q <br /> R If not,explain, <br /> w , J <br /> C <br /> Application. A rove enied Reason for Denial: o <br /> P <br /> d 0 <br /> Land Use: Date: - J `� <br />