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Burnett County Subdivision Permit Application Fees(mustaccompany form): <br /> Pre-Application Form Subdivisiojt w/o Survey: <br /> and/or $lo.00 <br /> Subdivisi w/Survey:$100.00+$I5.(Hl/lot <br /> Owner: 0r/1' 6/r/fUGXMO.) rp E/�VG.Y 0713 LvvKr'L <br /> Address: <br /> / R <br /> Cftwy C44t< laid Zools Phone: t7!• 6I 8 • fT9t <br /> Orieinal Parcel Information <br /> Oto- 43/0-0/-fe �. <br /> Parcel Identification#: to• 411(0-D/->ROra Section Township O Range 0 <br /> Original Description(or attach copy): Gay t 4.+i 3 e*,,o; d 7 c , C <br /> a 3 <br /> Current Zoning: R Z Floodplain&N: 4AArr Wetlands YIN: 1#4 <br /> R Lake/River Classification: 2 Name of Water Body: C.>t..c <br /> New Parcel Information j <br /> N <br /> Proposed New Legal Description and Parcel Size: <br /> A <br /> Acres ZS. 2 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary m p requirements.) <br /> Proposed access to public road: SA.Wn 71" 019W X04#0 10C.I <br /> d <br /> Signature of Applicant: _O Date: <br /> QJ <br /> ➢ Does parcel meet Zoning Requireme s? Y No p <br /> 0 <br /> �• ➢ Does parcel require a Survey? Yes No <br /> ➢ Permit application fees submitted? ❑ Amount$ 13D, D D Rec pt# 136 9 <br /> e <br /> re <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> a o <br /> �y w O <br /> $ If not,explain: C <br /> w w <br /> O C <br /> C p <br /> Applicatio Approv / Denied Reason for Denial: <br /> Land Use: Date: d <br />