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Burnett County Subdivision Permit Application Fees(must accompany-form): <br /> Subdivision w/o Survey: $10.00 <br /> and/or Pre-Application Form <br /> Subdivision w/Survey:$100.00+$15.00/lot <br /> Owner: LL_ jpwgfL <br /> Address: Qj Ni,,) Yo fL IL Ave_f\j r o <br /> A <br /> NLf - PO L/S M Phone: )J%� — z — ��` -7 <br /> z <br /> 0 <br /> Ori inal Parcel Information �Q <br /> Parcel Identification#: o <br /> _ t E—ZZO`j — bC/pQ Section Township Range <br /> J <br /> Original Description(or attach copy): <br /> a <br /> Current Zoning: ro Floodplain Y/N: �` y Wetlands Y/N: Gw <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> nf\/R p — x/ S w1 Gt✓ / <br /> Acres: / D <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided YIN: / W <br /> If yes,describe access: <br /> v <br /> Signature of Owner: A tf Lod r V rSt Date: <br /> Does parcel meet Zoning Requirements? Yes No <br /> Cn <br /> Does parcel require a Survey? Yes No <br /> Permit application fees submitted? Amount S d o Receipt# 16)y/ J n <br /> 0 <br /> B <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> c <br /> 7.7 A <br /> eIf not,explain: ' <br /> e <br /> as O <br /> y r <br /> T <br /> Application: Approv / Denied Reason for Denial: <br /> / <br /> Land Use: Date: /-/'-/' <br /> G <br />