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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Pre-Application Form <br /> Subdivision w/o surve;$ $10.00 <br /> and/or Pre-A <br /> pp Subdivision wl Survey$100.00+$15.00/lot <br /> Owner: te <br /> /� ftr- l <br /> Address: /�_�[ ) Pel 1 da el <br /> e-Apb6 TPhone: �/s <br /> Orieinal Parcel Information <br /> Parcel Identification#: OZ,�e 3WI 6 0/> Section Tpownship1 ` Range Z—7 <br /> Original Description(or attach copy): S f�/ �j[ �i�dt Lcai <br /> �� ���jn2 �Q1���P 5c��n�eP✓1 lyt'St ' <br /> X, Current Zoning: U ZO>7 Floodplain YQ Wetlands Y46;?Lake/River Classification: Name of Water Body: /von <br /> New Parcel Information <br /> Proposed New Legal`Description and arcel Size: 5-C —7y rf <br /> Acres: l f}C(2 5 PlrCh <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: &1C;e1lg- <br /> tv <br /> Signature of Applicant: _4!,� Date: eo <br /> �0 <br /> t <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> °-e• ➢ Does parcel require a Survey? Yes No , 1 4 <br /> ➢ Permit application fees submitted? ❑ Amount$ l� 0 t/ Receipt# /S ' <br /> e <br /> p <br /> 1-710 <br /> /� <br /> XReconciles with Real Property Lister Yes No Date: 00, <br /> CL <br /> If not, explain: <br /> e � <br /> M <br /> Applicatio . Approved Denied Reason for Denial: <br /> Land Use: Date: 2 <br />