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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 Subdivision w/Survey:$100.00+$15.00/lot <br /> Owner: 1 d'GLL <br /> Address: 507 , qdzl�_ y <br /> / Y( AIA/eW011,j MAI 5`71 /�7 Phone: <br /> DZo 431�'D�810 d Ori in iParcelInformation <br /> Parcel Identification#: JZ'q312'OZ� 6 Section 12"/.3 Township YJ41 Range /6 w <br /> Original Description (or attach copy): G L• y /z G• L- <br /> l,t/C 05m V l9 12 <br /> a <br /> m Current Zoning: IFZ FloodplOMLON: Wetlands(PN: <br /> Lake/River Classification: C/ass 3 Name of Water Body: ofzoo4 <br /> New tarcel Information <br /> Proposed New Legal Description and Parcel Size: C✓�9T1 ��/ ni LO� <br /> Acres: y35 t <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> �j p d <br /> Signature of Applicant: y' Date: 0 4 Ac <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> 0 <br /> �• ➢ Does parcel require a Survey? Yes No <br /> 00 0 <br /> ➢ Permit application fees submitted? ❑', Amount$ Receipt# 9 <br /> e <br /> n <br /> r ❑ Reconciles with Real Property Lister Yes No Date: <br /> m <br /> e <br /> a <br /> If not,explain: <br /> 0 <br /> a I <br /> Application: Approved / Denied Reason for Denial: <br /> Land Use: Date: <br />