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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> and/or Pre-Application Form <br /> Survey of Existing Parcel: $50.0011'f <br /> +$50. <br /> pp Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner: /VE/G O, LAnSonl ro <br /> A <br /> Address: �SlP Z- K/At FISNE/z.. Lnl g <br /> ,aoLztJ P/ZA (a1C- "/I] 553f- , Phone: 95Z - 3a3 - 3232 <br /> Orizinal Parcel Information <br /> 00 <br /> Parcel ID#: 67-81- /Z3 a Z 5oo Section z.3 Township 4-0 Range /4- LU <br /> Original Description(or attach copy): sk/* SW'/4- p <br /> e <br /> b Z Floodplain Y/N: A/ Wetlands Y/N: Al <br /> Current Zoning: A �. <br /> -- <br /> o Lake/River Classification: Al A Name of Water Body: <br /> New Parcel Information �, t-} P dsS-cA-,7 <br /> Proposed New Legal Description and Parcel Site: Z,5 76 3 AC/z E L-°;- B✓ G$M <br /> !/.1O c=2 pGsnlS lTy DEYGGop/vr Erni JZUc.E /it/ SG-� C/o/L-nI�ZZ- <br /> OF THE -5y'1¢ o'= 7Z",57 .SW//4-- Acres: Z,S- 3 4 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> a8o13 <br /> Proposed access to public road: _ /{,}S 6,E OA) Coc/NTV /Z-P /9 <br /> Proposed access to public waters to be provided Y/N: . // <br /> v <br /> If yes, describe acce _ <br /> A <br /> 2/ <br /> Signature of ner Date: <br /> G fL <br /> oN ➢ Does parcel meet Zoning Requirements? Yes No 913 <br /> 0 <br /> ➢ Does parcel require a Survey? Yes No rj i <br /> 0 <br /> I <br /> > Permit application fees submitted? Amount$ ���r7� Receipt# _ <br /> re � <br /> t" ❑ Reconciles with Real Property Lister Yes No Date: <br /> o Q 1 <br /> C6 <br /> qy If not,explain: <br /> n, I <br /> IJ <br /> e <br /> n <br /> a <br /> Application Approve / De 'ed son for ial: <br /> v <br /> Land Use: Date: <br /> BURNETf COUNTY <br /> ZONING <br />