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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+$15.00/lot <br /> Owner: �`hR�I�S �l G/l�1GZ Kllil�lC <br /> ro <br /> Address: 8 <br /> 6r(tWn MZ `IV(,37 Phone: o27& <br /> / Original Parcel Information / <br /> Parcel Identification M 093-gl a a - 6,1-,30 6 Section oZ a Township L10 Range l <br /> Original Description(or attach copy): IUM)M) <br /> O <br /> e <br /> m <br /> Y <br /> 9 Current Zoning: �/L'-3 Floodplain Y� Wetlands Y& <br /> e Lake/River Classification: N/� Name of Water Body: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: LIDI Ut �a <br /> SY <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map.. See attached for preliminary map requirements.) <br /> Proposed access to public road: ( /( /i1 A <br /> Proposed access to public waters to be provided <br /> If yes,describe access: tC <br /> m <br /> A <br /> Signature of Owner: t <br /> N ➢ Does parcel meet Zoning Requirements? Yes No 0 <br /> o � <br /> p ) <br /> ➢ Does parcel require a Survey? Yes No <br /> ( ' A <br /> Permit application fees submitted? Amount$ Receipt# Q T 3 <br /> b <br /> c <br /> A <br /> ❑ Reconciles with Real Property Lister Yes No Date: ^ <br /> a d <br /> 7y If not,explain: 5u <br /> � OO <br /> � 1 <br /> Applica ' : Approved,/ Denied Reason for Denial: C <br /> Land Use: Dae: — ✓c/l <br />