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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> and/or Pre-Application Form Survey sionof ExistingSurvey: <br /> $ 00.0$50.0+55 <br /> n� L� pp Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner: ✓/`�,J.N/ (J D <br /> Address: <br /> _21�.5 & P <br /> Phone• � <br /> L /14k-L." Ori2pinalParcelInformation QJ <br /> Parcel lD#: t�d6 - 13a3-Op2.00 �S`ectiio/n �.3 Township N/ Range <br /> Original Description(or attach copy): Pe v <br /> Z dy �� p <br /> Du.( V qSS py2o¢ LaII1 D- 635 <br /> s <br /> n <br /> Current Zoning: ipe Floodplain Y/ Wetland 7 N: y ,, ✓� <br /> e Lake/River Classification: Name of Water Body: `Vt�i�/)'17i- r� �%•' <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: / pGzh,Ce:C� <br /> Alew CSN' <br /> Acres: $C to <br /> (If <br /> parcel s surveyed,provide reliminary map. See attached forprel!im_JiOnZarGy/map requirements.) <br /> -requirements) <br /> Proosed access topublcoad <br /> Proposed �T <br /> access to public waters to be providedtN: L4fe Gaey C3 <br /> d <br /> If yes,describe access: m <br /> Signature of Owner: Date: <br /> e ➢ Does parcel meet Zoning Requirements? Pes No <br /> Does parcel require a Survey? No n <br /> 0 <br /> Permit application fees submitted? ❑ Amount$LYL) Receipt# � <br /> ee <br /> z <br /> m ❑ Reconciles with Real Property Lister Yes No Date: 't <br /> o O <br /> a <br /> qy If not,explain: p <br /> a -C <br /> H W <br /> _ N <br /> 1 <br /> Applicat' n: _ Approved / enied Reason for Denial: Q <br /> � I <br /> N <br /> O <br /> Land Use: Date: <br />