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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form Subdivision w/o Survey: $10.00 <br /> pp Subdivision w/Survey:S 100.00+$I5.00/bt <br /> Owner: 6e_rn 04 On n 6,Kn/'l�.� <br /> ro <br /> Address: <br /> J,�l9nI7 E' er X11 ,�/$�O� Phone: <br /> Original Parcel Information <br /> Parcel Identification#: 6d18- Y/103 -a/C%d0 Section J-3 Township Range /</ <br /> Original Description(or attach copy): /U hJ ;N- /l/ k) Vy <br /> O <br /> 0 <br /> a 7 <br /> Current Zoning: Floodplain Y/N: 41 Wetlands Y/N: /kl� <br /> oLake/River Classification: /1/A Name of Water Body: <br /> New Parcel Information 1� <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: <br /> S <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) R <br /> Proposed access to public road: l.i1 i),& Id <br /> Proposed access to public waters to be provided Y/N: /1/ <br /> If yes,describe access: p <br /> w <br /> Signature of Owner: Date: 5'67 <br /> i <br /> e ➢ Does parcel meet Zoning Requirements? Yes No (S) <br /> o p <br /> ➢ Does parcel require a Survey? Yes No .J <br /> n <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# /D 3 <br /> b <br /> e <br /> ❑ Reconciles with Real Property LisYes No Date: <br /> If not,explain: <br /> n W <br /> K <br /> CN <br /> Applicata : Approved / nied Reason for Denial: <br /> Date: <br /> Land Use: <br />