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Burnett County Subdivision Permit Application Fees. (must form): <br /> and/or Pre-Application Form Subdivision w/oSurvc�: $10.00 <br /> �{ A Subdivision w/Surveysi w.()0+s I5.(N)/lol <br /> Owner: �/Jp(,ZGI� I I ZRI/�f i p <br /> Address: A <br /> ole-y 3z� — <br /> Phone: <br /> 029d0- 0 3000 - 0'50 1& Original Parcel information <br /> O�iZvo - u 330" % <br /> Parcel Identification#:Q -y32'7-b 5166 tion 2-q Township�Ran e <br /> g <br /> Original Description(or attach copy): 541' i�y <br /> E <br /> A <br /> s �y <br /> 3 ' <br /> Current Zoning: <br /> A z ro ,0 <br /> Floodplain Wetlands Y <br /> Lake/River Classification:-_Name of Water Body: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> y�- <br /> 1 <br /> Acres: <br /> (If parcel is to be surveyed,provide Preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Signature of Applicant: /^')a'L'- 2 -c. Ki24tc c� 9-G�_ <br /> Date <br /> C>° <br /> N ➢ Does parcel meet ZoningRequirements7 No <br /> e <br /> m <br /> Does parcel require a Survey? Yes No � <br /> ➢ Permit application fees submitted? ❑ Amount n <br /> $ ° <br /> Receipt# 3 <br /> 11 Reconciles with Real Property Lister Yes No Date: <br /> C6 <br /> o <br /> d <br /> If not,explain: ° o�Q <br /> ��J JJJ <br /> w0 000 <br /> Application: pprov / Denied Reason for Denial: <br /> WWI <br /> K'�p o00 <br /> 00 Opp' <br /> Land Use: Date:_ <br />