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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form Subdivision w/o Survey: $10.00 <br /> .ryp pp Subdivision w/Survey:$100.00+$15.00/bt <br /> Owner: PEIM ;5EIU6 FAVr <br /> t` Address: <br /> 2(70 I { �ICD�f Cl2 GD Be kSJ 3 3 <br /> Lo e: 2 <br /> (9011T 4k RIO CQ TX lk� L (N <br /> 22 (Orieinal Parcel Information <br /> Parcel Identification#: J 3y_ DU Vection Township ->T Range <br /> Original Description(or attach copy): L-6-r C/ V T Z y Z•�? C <br /> D«a(i3J ff144 d,,.( 01 3.T22zo <br /> > �l <br /> � k R <br /> Current Zoning: �JZnue' Floodplain(gVN: etla/nnds' . <br /> Lake/River Classification: 3 Name of Water Body: P/ IC e <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: t� l7 <br /> Acres: t0 <br /> (If parcel is to be surveyed,provide preliminary map. See attached <br /> for preliminary map requirements.) <br /> Proposed access to public road: <br /> y� d <br /> T Signature of Owner: r Datei: 3 Ait " 67 <br /> W <br /> G <br /> > Does parcel meet Zoning Requ ements? ' Yes ) No p <br /> N � <br /> > Does parcel require a Survey? Yes No n <br /> > Permit application fees submitted? ❑ Amount S So, D Receot# % Sy7 9 <br /> e <br /> z <br /> r <br /> ❑ Reconciles with Real Property Lister Yes No Date: p <br /> a <br /> If not,explain: _ w <br /> wW <br /> a <br /> N� Vl <br /> Wo <br /> W <br /> Application Approved Denied Reason for Denial: t w <br /> 0 0 <br /> Land Use: Date: 3 �U <br />