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Burnett County Subdivision Permit ApplicationEubd <br /> (must accompany form): <br /> and/or Pre-Application Form ivisionw/o Survey: $10.00 <br /> pp divisidn w/survey:$I00.00+$15.00/lot <br /> Owner: f� � <br /> Address: a31 PZ, er50 Aj <br /> 3 <br /> 6q:g92 Phone _T�_Nq_98yl P2 <br /> 006-2—Li (3-61-366 Original Parcel Information <br /> Parcel Identification#b66"24I3'6I- gf)f7 Section /3 Township Range 4✓Y <br /> Original Description(or attach copy): Al bU t y 41 E t e/ <br /> F <br /> e <br /> n, <br /> 9 <br /> Current Zoning: L ti ZD iJ e.a Floodplain Y19 Wetlands Ye <br /> q <br /> Lake/River Classification: Name of Water Body: <br /> New Parcel Information o' <br /> Proposed New Legal Description and Parcel Size: C6'/Y) P <br /> Acres: 1'�2. 5.21 cl; <br /> 0 <br /> (If parcel is to be surveyed, Provide preliminary map. See attached for preliminary ma p requirements.) <br /> ) <br /> t <br /> Proposed access to public road: . T, t q,6 <br /> Signature of Owner: %/.[y . Date (o p <br /> 6� <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> 00. <br /> ➢ Does parcel require a Survey? Yes No J <br /> n <br /> ➢ Permit application fees submitted? ❑ Amount$ IIS. O O Recei 2t# �� B <br /> e <br /> rt <br /> r ;e <br /> ❑Reconciles with Real Property Lister Yes No Date: o <br /> If not, explain: <br /> W � <br /> d <br /> Application: Approved / Denied Reason for Denial: <br /> OC <br /> O <br /> Land Use: Date: <br /> i <br />