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Burnett County Subdivision Permit Application Fees(must accompany forml: <br /> and/or PreA lication Form Subdivisionw/o Survey: $10.00 <br /> a <br /> an PPl� Subdivision w/Survcy:$100.00+515.00/lot <br /> Owner: ,, /UAA, "Q/„djol T� rm A/dad-� <br /> Address: FJI <br /> Phone: o <br /> OHpinal Parcel Information u � <br /> ,` / /0Range <br /> Parcel Identification#: OrYiJ� —��JS—D/7/d Section 5 Township_ S <br /> Original Description(or attach copy): 6.L• 7 Gy� 0 <br /> e <br /> A <br /> 1' <br /> a L <br /> rr/� <br /> Current Zoning: fu 2y Floodplain 1(9) Wetlands Y& ' <br /> Lake/River Classification: Name of Water Body: <br /> l <br /> New Parcel Information <br /> /n1 <br /> Proposed New Legal Description and Parcel Size: <br /> l <br /> Acres: <br /> 5. o <br /> (If parcel is to be surveyed,provide preliminary map. <br /> See attached for preliminary map requirements.) <br /> Proposed access to public road: W,r,W arl.(IYVYI,” 4&c et i3O.. <br /> Signature of Applicant: Date: <br /> ➢ Doesparcel meet Zoning Requirements? Yes No 30 O <br /> e <br /> Does parvel require a Survey"? Yes ` No <br /> _ <br /> Permit application fees submitted? 11 Amount$ i /5`U U Receipt# l) a <br /> e <br /> ❑ Reconciles with Real Property Lister Yes No Date: x <br /> a O <br /> RIf not,explain: o <br /> o t <br /> a � <br /> Application: pp / Denied Reason for Denial: o <br /> J <br /> Land Use: Date: &O 9P 0�- O <br />