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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form Subdivision w/o Survey: $10.00 <br /> an or Pp Subdivisio w/Survey:$100.00+$15.00/lot <br /> Owner: V�AQ(—G <br /> Address: 0 3(0 5_pyt_ 2D "T') <br /> LOj�� � � ��� y� / r7 3 <br /> _M idukc- W1 �N83o Phone: "/I fo56" tb y o <br /> Original Parcel Information •/ / J <br /> Parcel Identification M 6I�332q_b 6WSection�Township 3 /i1 Range,L6_"Y <br /> Original Description (or attach copy): ME !3Ei2art 6 L6-r <br /> D /n v ) l P 2L9- ata <br /> Gr -Z2a <br /> Current Zoning: Floodplain Y& Wetlands <br /> Lake/River Classification: Name of Water Body: 4b <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: �M <br /> Acres: u <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 3 <br /> d <br /> m <br /> Signature of Owner: Date <br /> ➢ Does parcel meet Zoning Requirement Yes No <br /> N _ <br /> ° J <br /> ➢ Does parcel require a Survey? Yes No <br /> n n <br /> ➢ Permit application fees submitted? ❑ Amount S l 0 d Recei t# <br /> c <br /> n <br /> ❑Reconciles with Real Property Lister Yes No Date: O# <br /> a <br /> If not,explain: <br /> o0 <br /> a W <br /> I <br /> Applicatio Approved / ied Reason for Denial: p <br /> d <br /> Land Use: Date: �� 0 7 a <br />