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Burnett County Subdivision Permit Application Fees(mustaccompanyform): <br /> Subdivision w/o Survey: $10.00 <br /> and/or Pre-Application Form Subdivision wl Survey:$100.00+$15.(I011ot <br /> Owner: Jac.K W I I za1�l� <br /> Address: 6`7 I'1 oltm I S 4 u"`x Kd <br /> �UP� er (Al i 5ggq3 Phone: L(O- <br /> ozo-y3z� — <br /> O29o0- 0 3000 - 0'50 I'D OriLdnal Parcel Information <br /> 03zoo -- 0 -:3304, <br /> 300 2angeParcel Identification#: C)26Section Z1 TownshiU <br /> Original Description (or attach copy): I r 5 w �N �A/ !� O <br /> a <br /> 09 <br /> Current Zoning: 2__ <br /> fib Floodplain le Wetlands Y <br /> Lake/River Classification: Name of Water Body: �— <br /> Y <br /> New Parcel Information R £ <br /> Proposed New Legal Description and Parcel Size: C S /Yl (y I el 101:5 s <br /> J <br /> AAcres: 39s <br /> (If parcel is to be surveyed,provide preliminary map. See aattached/ for preliminary map requirements.) /� E <br /> Proposed access to public road: C6 U�n Gad <br /> d <br /> Mp O� m <br /> Signature of Applicant: I ' 1 VLJZ Date: <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> 0 <br /> '-�• ➢ Does parcel require a Survey? ci'� NO n <br /> � o <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# 9 <br /> e <br /> ac <br /> a ❑Reconciles with Real Property Lister Yes No Date: <br /> S ` <br /> F <br /> 4 <br /> If not,explain: w <br /> d 00'O O � <br /> Application<Approve / Denied Reason for Denial: o <br /> Date: <br /> Land Use: �� �� <br />