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Burnett County Subdivision Permit Application iny form): <br /> uvsonwu $1.0000 <br /> and/or Pre-Application Form ey:$100.00+ <br /> $IS.00IIot <br /> Owner: <br /> 1 / A <br /> Address: 7- (o4. <br /> M A?LJEkloot_ I Mi-J . 5­5to3 Phone: 5 <br /> Original Parcel Information <br /> oz$ -q'pd 'ol -'"loo <br /> Parcel Identification#: 029,-4\c4- a I - 9c o Section 1} Township Range 1 <br /> Original Description(or attach copy): DEED Z in A LSo <br /> 3 z� —� 3 89 0 . <br /> a <br /> Current Zoning: 2�r Z Floodplain Y/N: Wetlands Y/N: C <br /> n <br /> °m. Lake/River Classification: (—�LssS z- Name of Water Body: l 5 (- V E <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: SEa �(FkZI 1_6 : 9 <br /> Lo-r d r 0.5 35 0 .4 62- Ac. e-e;, Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: C kk STi E-Lo R E P Ffzi.!q E 4S� E[�-t-• <br /> Proposed access to public waters to be provided Y/N: <br /> If yes, describe access: C <br /> m <br /> / A <br /> Signature of Owner: Date: i V <br /> 1 <br /> e ➢ Does parcel meet Zoning Requirements? Yes No <br /> 01 <br /> ➢ Does parcel require a Survey? YesNo <br /> Permit application fees submitted? ❑ Amount$ G U Rece [# / 0 <br /> 3 <br /> 'o <br /> e <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> a a <br /> If not,explain: <br /> n i <br /> a i � <br /> H 1 <br /> O <br /> Applicati Approved / D ted. Reason for Denial: <br /> C> <br /> Land Use: Date: O <br /> i <br /> Cl <br />