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Burnett County Subdivision Permit Application iccompanyform): <br /> Subdivisio w/o Survey: $10.00 <br /> / and/orPre-Application Form w/Survey:$100.00+$15.00/lot <br /> Owner: Qt4W nn2CgQu1 k&J 647C1E' <br /> Address: /b 1 ,056 tV> Std-349-ZyYB 3 <br /> 55Phoe: <br /> 618-3335-65� Original Parcel Information <br /> Parcel Identification#: Q18-33�- 653W Section 3 Township 3 tV Range <br /> Wt�T0 d <br /> Original Description(or attach copy): Q� _ 61C "T 16 <br /> I O -f 9 tc(Sov`_� <br /> e <br /> Z <br /> Current Zoning: U AJ Floodplahi(Y)N: Wetlan C <br /> Lake/River Classification: CSS ( Name of Water Body: � <br /> P <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: Cpm S <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary ma 3 requirements.) <br /> Proposed access to public road: r7 b <br /> d <br /> d <br /> Signature of Owner: Date <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> o `r <br /> �• )oDoes parcel require a Survey? Yes Nd <br /> ➢ Permit application fees submitted? ❑ Amount S 5D,O 0 Recei t# <br /> e <br /> m <br /> r <br /> ❑ Reconciles with Real Property Lister Yes No Date: p <br /> a <br /> If not,explain: <br /> wW <br /> a <br /> y W <br /> Applicatio . Approved / enied Reason for Denial: 0 L� <br /> Ga <br /> Land Use: Date: - Y'� <br />