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Burnett County Subdivision Permit ApplicationEFemu"accompany Form):visiotY w/o Survey: $10.00/Iand/or Pre-Appliication Form visio' w/Survey:$100.00+$15.00/lot <br /> Owner: _ IV I kgs <br /> A <br /> Address: 2-318e /Pe'�fierso�l Koo-d np 3 <br /> /�ZF/✓1 W / '5yg97 Phone: <br /> /-6I-366 Original Parcel Informattion <br /> Parcel Identification#666-2'7 313-6 I- g()O Section /3 Township Range �/ ✓t <br /> Original Description(or attach copy): AJW 1 y 4/E VV &t <br /> i Al,Uj p <br /> f <br /> eDO <br /> 0 <br /> �A 000 0 Z_k <br /> Current Zoning: Floodplain Y& Wetlands N: <br /> Lake/River Classification: Name of Water Body: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: d <br /> Acres: ��• �2— <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: .5. 777Y. 1117,611 <br /> d <br /> d <br /> Signature of Owner: Date <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N <br /> 0 <br /> �• ➢ Does parcel require a Survey? Yes No <br /> n <br /> 0 <br /> ➢ Permit application fees submitted? ❑ Amount S Recei t# <br /> e <br /> ra <br /> r ?� <br /> ❑Reconciles with Real Property Lister Yes No Date: <br /> c <br /> If not,explain: <br /> 0 <br /> a <br /> H <br /> Applicatio Approve / Denied Reason for Denial: n <br /> Land Use: Date: —�/ <br /> IIS <br />