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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form Subdivision w/o Survey: 00 <br /> pp Subdivision w/Survey:$100.000.00+$15.00/lot <br /> Owner: ff)Erava1y: ✓l.. 15oytnFz LIimwmQ '-J <br /> Address: Tj 50 k S [3E6y Ez 1.1 coo v_ A'V E. � <br /> a <br /> span 1E tZ lXl2 S�S6 I Phone: 6P <br /> Original Parcel Information <br /> Parcel Identification#: 0ZA-141'54 -OZ -CD©0 Section 3-4 Township Range r <br /> Original Description(or attach copy): DEEED S7oc '$ 35 Z '3 ec SU <br /> _ <br /> FAtz-r- of G• L. Ce . 5E e- 3� 1 '-7-'4e� r�.� t 21.4 W _ O <br /> A <br /> Current Zoning: fzR 3 Floodplain YIN: FJ Wetlands YIN: 1J <br /> o Lake/River Classification:11-:r orl wq_Mz Name of Water Body: >\�/� • [r <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: tiJ i=A/Q G S.M. [ir=e daz Ev o r( <br /> 17C—s-o � 35Z9O(o 1 Ey-157'� r1V l��¢-c�L . gg <br /> -1 <br /> Acres: 9 S <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) T <br /> Proposed access to public road: 1 T A-C3aT5 Vu a r_r e- V_'�a p <br /> Proposed access to public waters to be provided Y/N: 1S G <br /> If yes,describe access: <br /> m <br /> 8- VrJG ° <br /> Signature of Owner:Vo-r,Jr& MEKAt5cm of (3 r ego J ate: 4ut, u ST 3o zoo-I <br /> i <br /> c ➢ Does parcel meet Zoning Requirements? Y No <br /> 0 <br /> ➢ Does parcel require a Survey? Yes <br /> /� / / 0 <br /> D Permit application fees submitted',( Amount$_�, 0`j Receipt# <br /> e <br /> m ❑ Reconciles with Real Property Lister Yes No Date: <br /> o � <br /> a r <br /> �y If not,explain: R) <br /> n � <br /> o � <br /> a � <br /> U1. <br /> -G, <br /> I <br /> Applicatio : A roved / enied Reason for Denial: a <br /> Date: <br /> Land Use: ��� <br />