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Burnett County Subdivision Permit Application Feescmust'liccompanyform): <br /> and/or Pre-A 1 cati n Form Subdivisio w/o Survey: 00.00 <br /> p Subdivisio w/Survey:$100.00+$15.00/lot <br /> Owner: <br /> Address: <br /> Poe: <br /> Or ina Parcel Information <br /> Parcel Identification#: d l> Section . Township Range ! <br /> Original Description(or facK covy):3G G� SCG <br /> O <br /> e <br /> A <br /> 1 <br /> > _3 �� <br /> Current Zoning: FI odpl in Y N) �— Wetlands Y' "} r <br /> n _ C <br /> o Lake/River Classification: —�'— ame of Water Body <br /> New ParcelInformation 4- <br /> Proposed <br /> Proposed New Legal Description and Parcel Size: <br /> / ar <br /> res Q <br /> If parcel is to be surveyed,provide preliminary nap. See ched t r r liminar ma requirements.) <br /> 3 <br /> Proposed access to public road: <br /> Proposed access to public waters to be proi ided /N: <br /> If yes,describe access: C <br /> m <br /> A <br /> � <br /> Signature of Owner: Date: J � <br /> ➢ Does parcel meet Zoning Requirements? Yes_D No O <br /> 0 <br /> ➢ Does parcel require a Survey? Yes o J <br /> n <br /> Permit application fees submitted? E Amount S I D, b b Rece t# J� <br /> 3 <br /> e <br /> m ❑ Reconciles with Real Property List Yes No Date: 1 c, 0+ <br /> 0 <br /> xt <br /> a p c <br /> � If not,explain: �w <br /> A <br /> O <br /> � 1 � <br /> w 4- •(,. <br /> O O <br /> Applicatio Approved / nied Reason for Denial: o <br /> � d <br /> C c <br /> Land Use. h Dale: J —d� <br />