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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 /> Owner: nr Subdivision wlSurvey:$100.00+$15.00/lot <br /> I.IC'Lil /l (�t�f <br /> Address: 4-o A <br /> l.� 53963 <br /> '7 i Phone: Z <br /> 0 <br /> Ori linall Parcel Information <br /> OZa x/333 02 — <br /> Parcel Identification #:Q26—tils,3- 6=_Section 33 Township VOAJ Range //a ✓V j <br /> Original Description(or attach copy): ,Z� W <br /> 0 <br /> F <br /> e <br /> n <br /> a <br /> Current Zoning: Floodplain S Wetlands Y <br /> Lake/River Classification: Name of Water Body:_— e� <br /> Q <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: C 5� <br /> L 3� <br /> Acres: <br /> (if parcel is to be surveyed,provide preliminary_ map. Seattached for preliminary <br /> map requirements.) <br /> Proposed access to public road: 5 -n-C <br /> Signature of Applicant: C <br /> Date: A <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N <br /> ➢ Does parcel require a Survey? Yes No b <br /> as <br /> ➢ Permit application fees submitted? ❑ Amount$__!i0_0 to Receipt# D Q 3 <br /> 9 <br /> C <br /> m <br /> � <br /> 11 Reconciles with Real Property Lister Yes No Date: <br /> a <br /> TJ o O <br /> e If not,explain: 0 0 <br /> a ` <br /> W W <br /> W W <br /> W W <br /> C � <br /> Application Approved enied Reason for Denial: of v <br /> ZI C o <br /> Land Use-._ttEa;� Date: Id o u <br />