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Burnett County Subdivision Permit Application Dees(must accompunc forint <br /> Subdivision Wo Survcv: 510.00 <br /> and/or Pre-Application <br /> �Form -{ SubivisionudSurwe,:$101.00+$Ii.(Glot <br /> Owner! t/'ZsUNe /// / lim .41&u%c & & � <br /> G ty � / z lzi <br /> z zo5 <br /> Address: n /� , - <br /> I��l�K //N( 55/14 as�yJz Phone: e <br /> ;I oz6-y3/9-0 3300 Orh[inal Parcel Information <br /> .el I ttRi e.itc3n 71— '1319-11 Section , p Township J0/U Range /O IN/ <br /> J) <br /> Original Description(or attach copy): �h11�4 fy �'/� N Uj fly S Uj /g/ p <br /> 71us m ��d171�QeDDen/i22t��(JD �OyS l9 3e��fagp//a /" -ze QO <br /> a Current Zoning: Floodplain(gN: Wetland12�`N: }� <br /> a <br /> Lake/River Classification: Lv lI M Name of Water Body:—*kw y <br /> Y <br /> New Parcel Information ,,t/ <br /> Proposed New Legal Description and Parcel Size: c6 ` t U 1 SS-8 0Y- <br /> 3 <br /> .P�Ci'r�i y�ahca� �J <br /> Acres: /a .9 <br /> (If parcel Is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> / <br /> Proposed access to public road: 6olurla,,n toad — LW11 //LQ/i1 �(J cCLC <br /> Signature of Applicant: /t sfrrVr- Date: 7/b A • <br /> J <br /> r <br /> ➢ Does parcel meet Zoning Requirements? Yes No b <br /> o <br /> ➢ Does parcel require a Survey.' Yes No <br /> w o <br /> ➢ Permit application fees submitted? ❑ Amount$-)V^• Db Receipt # 9 <br /> e <br /> 2 <br /> L <br /> n Reconciles with Real Property Lister Yes No Date: a a <br /> If not,explain: <br /> o t <br /> W d <br /> Applicatio Approved / enied Reason for Denial: •� W <br /> 00 0 <br /> � Oi7 d <br /> Land Use: F' Date: (7 <br />