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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: $10.00 <br /> a�n�`d//or Pre-Application Form Subdivision w/Survey: $25.00+$5.00/lot <br /> Owner: /� c6 &LL Z_2a"2Jat_,,1 <br /> Address: aD Gs Rd- <br /> 2E 4,5� U-)T SZ 3 Phone: / `7 <br /> y <br /> Original Parcel Information •v <br /> Parcel Identification #: (f/R 6 —Q/Se 6102) D Township V6 Range 3 <br /> q � 0 <br /> Original Description (or attach copy): /V 6AI <br /> Current Zoning: — Floodplain Y/N: A— Wetlands Y/N: l <br /> Lake/River Classification: Name of Water Body: <br /> m <br /> 0 <br /> w <br /> New Parcel Information / // <br /> Proposed New Legal Description and Parcel Size I N / �- � Va ! V�'E /V U — /Q R ' <br /> _0 C0_4t,e_ alas`l0_ I\1€n!L�) —1 o ° <br /> N Y.)— N'C N 0 ` a D Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: c Late, <br /> Proposed access to public waters to be provided Y/N: f V v <br /> If yes,describe access: JUL 16 M,,, <br /> i <br /> ➢ Does parcel meet Zoning Requirements? YesNo zQN)NQ N71' t <br /> N <br /> ➢ Does parcel require a Survey? Yes Q <br /> 00 3 <br /> ➢ Permit application fees submitted? Amount$ Receipt # <br /> A <br /> r u <br /> ❑ Reconciles With Real Property Lister Ye No Date: ! l e o <br /> a <br /> If not,explain: <br /> 0 <br /> y � <br /> Application: pproved / Denied Reason for Denial: o <br /> Land Use: Date: / d l C y <br />