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Burnett County Subdivision Permit ApplicationFeescmustaccompanyform): <br /> ! subdivision w/o survey: $10.00 <br /> and/or Pre-Application Form <br /> Subdivision w/Survey:$100.00+$15.00/lot <br /> Owner: _+ire .. ?rope <br /> Address: �_o 3 , Z i. <br /> Phone: <br /> z <br /> 0 <br /> Original Parcel Information 5( 53 <br /> 5,- -Nw <br /> Parcel Identification#: 0 3i - 5 3 z 7 - n 1 , , Section z 7 Township 4 1 Range t 0 <br /> 03z -53z7_ oz2b p 5w-Nw <br /> a <br /> Original Description(or attach copy): <br /> hoc (', t 32,5Cd!o3 <br /> A <br /> T Current Zoning: Floodplain Y/N: Wetlands Y/N: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: / \/p rer ir(,1 <br /> X tS lt, PAV <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) V' <br /> Proposed access to public road: X t S / t CCPSS � 3� <br /> Proposed access to public waters to be provided Yl�� <br /> Ifyes, describe access: <br /> p b <br /> Signature of Owner: N rt rR✓Cgs (�N Ly Date: <br /> c <br /> D Does parcel meet Zoning Requirements? Yes No <br /> Does parcel require a Survey? Yes No <br /> O <br /> J <br /> D Permit application fees submitted? ❑ Amount$ rJU'ou Receipt# 1(]q R0 n <br /> 0 <br /> B <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> m If not,explain: x <br /> nc O <br /> h <br /> W <br /> I <br /> �S1 <br /> W <br /> Applicat' n: Approved / enied Reason for Denial: <br /> Land U 3 <br /> Date: 91 <br />