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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-A lication Form Subdivision w/o Survey: $10.00 <br /> Pp Subdivision w/Survey:$100.00+$15.00/lot <br /> Owner: 3o } t Linn4 � <br /> v <br /> m <br /> Address: '-IS"e S � ,, . � k sNE , <br /> 3 <br /> Sr- ?ez..' 1 rt s•, "s Phone: c t z <br /> - S5Pc— 1"158 <br /> Original Parcel Information <br /> Parcel Identification #: c 34 -i 4 z - Section z Township 3 7 Range l R <br /> Original Description (or attach copy): > P a „ , d- ze Rg z2 0 <br /> e <br /> m <br /> a <br /> � U <br /> e Current Zoning: �j p Floodplain Y�i:; Wetlands Y9C* o <br /> Lake/River Classification: k) A Name of Water Body: T,'„C 4 , k-v <br /> f_ <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: c s m' `p <br /> Acres: lc. 8c 27 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 62 ! <br /> d <br /> m <br /> Signature of Applicant: Date: A <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N G <br /> ➢ Does parcel require a Survey? Yes No <br /> -e' <br /> ➢ Permit application fees submitted? ❑ Amount$ O Receipt # <br /> e <br /> rD <br /> C ❑Reconciles with Real Property Lister Yes No Date: *k <br /> m <br /> 0 <br /> a O <br /> If not,explain: co <br /> o ,[ <br /> a <br /> N <br /> tt/ <br /> Applicatio Approved /)Denied Reason for Denial: c <br /> Land Use: Date: <br /> v <br />