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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: $10.00 <br /> and/or Pre-Application Form Subdivision w/Survey:$100.00+$15.00/lot <br /> c a <br /> Owner: / i'LP RSG/ S' �/'N //D70 <br /> Address: e 3 <br /> Phone: <br /> / , o <br /> Orieinal Parcel Information <br /> 3 <br /> Parcel Identification#: �/o _,3 y/l" D a (v OQ Section 1�Township 9 Range <br /> Original Description(or attach copy): .SE%yyzd /y <br /> O <br /> b <br /> Current Zoning: nZf3Yl Floodplain Wetlands <br /> a Lalce/River Classification:_ Name of Water Body: <br /> 0 Paye�lg New Parcel Information <br /> Proposed New Legal Description and Parcel Size: eq 5 f" 330 Tanf UT Y--A c-- <br /> ISE % AIW IV Z/- 39-/7 C <br /> oZNt! Dc 1. �t�es� 330 Tea v F _3E A,10 Acres: /0 0ow-c-S each <br /> S <br /> R <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 015'=A) /?oo12� <br /> 3 <br /> Proposed access to public waters to be provided YIN: /yd <br /> If yes,describe access: p <br /> m <br /> A <br /> Signature of Owner: Date: <br /> e ➢ Does parcel meet Zoning Requirements? Yes No <br /> ➢ Does parcel require a Survey? yes A'j <br /> 0 <br /> Permit applicationfees submitted? ❑ Amount$ /d' � � Receipt# <br /> 'v <br /> G <br /> t" ❑ Reconciles with Real Property Lister Yes No Date: <br /> If not,explain:kl,u i. 9 Varv/ 1_/q + 1/1 rs.� <br /> n � <br /> O � <br /> aW <br /> W t i C <br /> i <br /> Applicatio Denied Reason for Denial: <br /> 7"J t f 9l roGv Cc v, �. <br /> Land Use: Date: O <br /> O <br />