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Burnett County Subdivision Permit Application Fees(must accongmyform): <br /> and/or Pre-Application Form <br /> Subdivision $10.00 <br /> Subdivision w/Survey:$100.00+$15.00/lot <br /> Owner: M f&ri4 mr nrwe.It jr. <br /> Address: 7150 CkL &0Qd <br /> ��bAq jWI 5yk30 Phone: - I (1i5� (056- 3213 <br /> Original Parcel Information <br /> do0 9 <br /> Parcel Identirication #: 2-9SI5-05- fano Section 2% TownshipRange I( 0J e <br /> Original Description(or attach copy): 160 (-o.,. <br /> C> <br /> 0 <br /> Current Zoning: _ Floodplain Y&�_ Wetland(Y <br /> 9 <br /> a• Lake/River Classification: � <br /> Name of Water Body: --- <br /> New Parcel Information T <br /> Proposed New Legal Description and Parcel Size: 1 - Li Iek S Yy1 <br /> - Csvn y loos <br /> a <br /> Acres: 5.q <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) _ <br /> Proposed access to public road: I Ch-.-ti <br /> Proposed access to public waters to be provided Y/N: 0 <br /> If yes,describe access: <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> ➢ Does parcel require a Survey? Yes No e <br /> 9 <br /> ➢ Permit application fees submitted? O Amount 3 <br /> Receipt# A <br /> ❑ Reconciles With Real Property Lister Yes 0Qp <br /> n No Date: <br /> If not,explain: �vu <br /> a a " <br /> Appucati u: Approved / nied Reason for Denial: 66 <br /> p 000 <br /> Land Use- <br /> Date: _(.'�'"11 2 --cJ S <br /> 2/18!1001 <br />