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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 /> PA Subdivision w/Survey:$100.00+S 15.00/lot <br /> Owner: �Q-Y 11l-N�l �S�l'I-Zb L'4 <br /> 911 D G ableS kd <br /> Address: 3 <br /> yy e bsw wr 5-43 /Qa 5 Phone: <br /> Original Parcel Information <br /> Parcel Identification#: 66Z0-t_}33Y-f)3-ioG Section a� Township /F Range / <br /> Original Description(or attach copy): �3 1k), Sw II 4 '/4 <br /> O <br /> c <br /> f9i <br /> a <br /> 9 Current Zoning: t� �- Floodplain Yjjp Wetlands Y <br /> A) <br /> 0 Lake/River Classification: � Name of Water Body: � <br /> t- <br /> New Parcel Information � <br /> Proposed New Legal Description and Parcel Size: yv I�a 3 '1c), Sw IL4 3�_1/�4 (E/ <br /> Acres: /o <br /> rG <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: G C(b'QS Po a-d <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: C <br /> d <br /> A <br /> Signature of Owner. GI1 Date: <br /> S!J <br /> e ➢ Does parcel meet Zoning Requirements? Yes No w <br /> ➢ Does parcel require a Survey? Yes No <br /> n <br /> Permit application fees submitted? ❑ Amount$ 10 ' C Q Receipt# r7 °g <br /> r c <br /> d Reconciles with Real Property Lister Yes No Date: <br /> o # <br /> X If not,explain: P <br /> n <br /> 0 <br /> CL � <br /> N .{rte <br /> K' <br /> Applicati Approved / nied Reason for Denial: p <br /> W <br /> Land Use: Date: d —G 7 <br /> O <br />