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Burnett County Subdivision Permit Application Fees(must ccompanyform): <br /> Mand/or Pre-Application Form Subdivisioi w/o Survey: $10000 <br /> / Subdivisio w/Survey:$100.00+$1 5.00/lot <br /> Owner: V A f� C <br /> Address: Ddo 57� e- 7� ' <br /> N Ylt �y831� Phone: 0 <br /> Cal <br /> Original Parcel Information oQ <br /> Parcel Identifies tion#: DID 3Ja9 06600 Section�Town/ship Range //a✓V —� <br /> Original Description (or attach copy): C S/y) V 1(p ;26 7 -;Z 7U <br /> O <br /> _ J V,�l <br /> Current Zoning uuzoue� Floodplain 'l J Wetlands <br /> Lake/River Classification: Name of Water Body: O <br /> R <br /> New Parcel Information (� <br /> Proposed New Legal Description and Parcel Size: <br /> 0 <br /> Acres: 9 _3<9 <br /> ? <br /> (If parcel is to be surveyed,provide preliminary map. See attached forpreliminary mal,requirements.) <br /> Proposed acees to public road: /. 3 <br /> v <br /> m <br /> Signature of Om ner: Date: A <br /> 5vrv{ r <br /> 2-10 7167 <br /> ➢ Does parcel eet Zoning Requirements? Yq No <br /> ° J <br /> ➢ Does parcel equire a Survey? Yes No <br /> 0 <br /> ➢ Permit appli ation fees submitted? ❑ Amount$ /4,5'00 Recei t# U 9 <br /> e <br /> n <br /> ❑Reconciles wi th Real Property Lister Yes No Date: o <br /> a �:o <br /> If not,explain: <br /> a U <br /> w <br /> I <br /> O <br /> Application pproved Denied Reason for Denial: e <br /> 0 <br /> C <br /> Land Us4,, Date:o?' o C <br />