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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: $10.00 <br /> and/or Pre-Application Form Subdivision w/Survey: $25.00+$5.00/lot <br /> j <br /> Owner: „0 6'r"4 Po I�f,'H h or k <br /> Address: 29169 >,,„w Ly/lp <br /> WeLa4-rt- L 1j. 3�J9� 3 Phone: 67il P,-7Y <br /> Original Parcel Information <br /> o0Ypoo <br /> Parcel Identification #: Z©'¢ 3 �6 '3 <br /> 32 -d7 7 ip 4 <br /> Section 23 TownshtS Range = <br /> 0 <br /> Original Description (or attach copy): C sn7 141 S <br /> Gotef L�� ( Lof3 1 �► z <br /> 0 <br /> y Current Zoning: I Floodplain Y/N: L-4 11.r Wetlands Y/ <br /> •o � <br /> �• Lake/River Classification: 2- Name of Nater Body: <br /> m <br /> 0 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: Go)'I/�/NR 0niG1tii►L Lo7"T <br /> CS /Yl U q -P c) res: 2. 14 Of <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) QTJ <br /> Proposed access to public road: ye-5 <br /> Proposed access to public waters to be provides 'l is (� p <br /> v <br /> If yes, describe access: <br /> ➢ Does parcel meet Zoning Requirement Yes No <br /> I <br /> ➢ Does parcel require a Survey? Yes No J � 1 <br /> �[ 9 <br /> ➢ Permit application fees submitted? Amount $ Le # n °e <br /> r <br /> M Reconciles With Real Property Lister Qes No Date$URNETT COUNTY a <br /> ZONING 91 <br /> If not, explain: <br /> 0 <br /> y llo <br /> ti <br /> Applicata n: Approved enied Reason for Denial: <br /> J <br /> I <br /> b <br /> .1 Use: �Date- <br /> )03 <br />