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Burnett County Subdivision Permit Application Fees(mast �eemPany fom): <br /> Subdivisio wlo Survey: $10.00 <br /> and/or Pre-Application Form Subdivisio w/Survey:$100.00+$15.00/lot <br /> Owner: I'lnoi+ Ct, u i-a <br /> ro <br /> Address: -79 1 u <br /> z <br /> S f r r i r S 4 8 7 Z- Phone: N14 q - 2l &t <br /> CN <br /> Original Parcel Information <br /> £1'j-333L - u3 -ZJO <br /> Parcel Identification#: ' v 8- 3 3 3 z - o -110 u Section 3 z Township Range tc- <br /> Original Description (or attach copy): Y. -7 s I 0 <br /> e <br /> m Current Zoning: Floodplain Y/N: Wetlands /N: <br /> Lake/River Classification: Name of Water Body: y <br /> r <br /> New Parcel Information S <br /> Proposed New Legal Description and Parcel Size: L c I I M <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary mf p requirements.) <br /> Proposed access to public road: SS r .+. <br /> d <br /> m <br /> Signature of Applicant: Date: <br /> � y�� Q <br /> ➢ Does parcel meet Zoning Requirements? ��" No J <br /> N <br /> ➢ Does parcel require a Survey? _- - Yes No <br /> a°oA <br /> ➢ Permit application fees submitted? 11Amount$ Receir t# % 5 a <br /> e <br /> re <br /> x <br /> m ❑Reconciles with Real Property Lister Yes No Date: <br /> � rJ n <br /> a <br /> a oc <br /> If not,explain: <br /> o w W <br /> c w W <br /> y � <br /> I <br /> Q p <br /> Application: Approved / Denied Reason for Denial: ^ <br /> 4i ,C <br /> 0 0 <br /> 0 p <br /> Date: <br /> Land Use: (� �r "� <br />