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Burnett County Subdivision Permit ApplicationLubd <br /> usaccompany form): <br /> and/or Pre-A lication Form isi w/oSurvey: $10.00 <br /> Pll isi nwlSurvey:$100.00+$15.00/l0l <br /> Owner: nAMES J3yNSo <br /> 1 Z 978 CuN7y �o� <br /> Address: J 3 <br /> ��t.-Jngl~a's _ eJI 9-4byo Phone: 3— �OI1 �0j <br /> OriOna7l Parcel Information / <br /> Parcel Identification#: OV?— .� <br /> —ZZ-OJ 310 Section —7 Township 0 Range ` <br /> Original Description (or attach copy): <br /> e <br /> m <br /> m Current Zoning: N Floodplain Y/N: N /� Wetlands /N: <br /> 0 <br /> Lake/River Classification: R Name of Water Body: <br /> New Parcel Information <br /> L <br /> Proposed New Leg 1 Description and Parcel Size: C /0 <br /> k4zl c.fc� s AC`2p 3 <br /> Csi ' 1 Acres• <br /> (If par el is to be surveyed, provide preliminary map. See attached for preliminary ma requirements.) <br /> Proposed access to public road: l vt� /� CePSS -jV <br /> d <br /> Signature of Applicant: Date: A <br /> J <br /> n <br /> ➢ Does parcel meed Zoning Requirements? Yes No � <br /> I <br /> °o ➢ Does parcel require a Survey? Yes No <br /> o <br /> ➢ Permit application fees submitted? ❑ Amount$ I3D.0 O Receip # <br /> o <br /> e <br /> A <br /> z <br /> ❑ Reconciles with Real Property Lister Yes No Date: 't <br /> a <br /> If not,explain: so <br /> o � <br /> z <br /> a vi <br /> J <br /> O <br /> Application: roved�enied Reason for Denial: W <br /> w <br /> ` O <br /> Date: <br /> Land Use: �✓ <br /> G <br />