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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Pre-Application Form Subdivision w/o Survey: $10.00 <br /> and/or <br /> D Subdivision w/Survey:$10.00+$15.(10/lot <br /> Owner: /}� J 4-'6� <br /> Sa98 � �Rd U <br /> Address: �j/JQ /' n 3 <br /> [ / d70 �U Phone: <br /> UI <br /> /� <br /> u Original Parcel Information / <br /> Parcel Identification#: d0" /3�9 Q1D d� Section 19, Township 7G� ' Range //a t'V <br /> Original Description(or attach copy): 1�KCCC • 5 W �y A[ kJ <br /> O <br /> E <br /> 0 <br /> m <br /> g �fq � �,,�'') <br /> Current Zoning: �_ Floodplain 'N'_'J Wetlands XOn <br /> n <br /> Lake/River Classification: Name of Water Body: <br /> New Parcel Informantion <br /> Proposed New Legal Description and Parcel Size: Gsm 1 <br /> Acres: 16• 00 <br /> (If parcel is to be surveyed, provide preliminary maLp.' ,See aattached-for preliminary map requirements.) <br /> Proposed access to public road: <br /> b <br /> m <br /> Signature of Applicant: Date: <br /> 09 <br /> ➢ Does parcel meet Zoning Requirements Ye No G <br /> °a• ➢ Does parcel require a Survey? des — No <br /> n <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# 3 <br /> 9 <br /> C <br /> A <br /> 11 Reconciles with Real Property Lister Yes No Date: <br /> n p <br /> If not,explain: o. <br /> o <br /> a s <br /> 0 <br /> Application: Approve / Denied Reason for Denial: <br /> Land Use: Date: <br />