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Burnett County Subdivision Permit Application Fees(must accompanrform): <br /> and/or Pre-Application Form Subdivision w/o Survey: $10.00 <br /> Subdivision w/Survey:S I1x1.(10+S I S w/lot <br /> Owner: lad <br /> Address: � l�`2`' <br /> W r lit ! Ic <br /> -qg I✓ Phone: <br /> 02e-y ° <br /> 02900- 0 3000 - 63e 10 Orieinal Parcel Information <br /> 03Zv4' - p 330c' ( n <br /> Parcel Identification #:QW -73-Z7-6-5166 Section Z� Township R(6 <br /> Original Description(or attach copy): 5 6L_'/L/ TAt �N l y <br /> O <br /> E <br /> e <br /> A <br /> s py <br /> 3 <br /> Current <br /> Zoning: A Z rd Floodplain )0Wetlands <br /> Lake/River Classification: Name of Water Body: <br /> New Parcel Information <br /> < <br /> Proposed New Legal Description and Parcel Size: / ) (,v ly n 1 Uf—z,, <br /> Acres: 39.0 4 .� <br /> Z <br /> (If parcel is to be surveyed, �s <br /> y ,provide preliminary map. See attached for preliminary map requirements.) 0 <br /> Proposed access to public road: _l (1 ulrh,, 2Dfi[Y �� _ I� ot� <br /> I . <br /> Signature of Applicant: I `e �� KIZ £.uA 'Z Y, 9_G�; <br /> Date: <br /> _ 1 � <br /> N ➢ Does parcel meet Zoning Requirements Aro <br /> QJ <br /> ➢ Does parcel require a Survey? Yes No <br /> n <br /> ➢ Permit application fees submitted? O Amount S Receipt# <br /> e <br /> m <br /> �Reconciles with Real Property Lister Yes No Date:_ <br /> a <br /> !o <br /> e If not,explain: <br /> � cz <br /> wwa <br /> Application: pprov / Denied Reason for Denial: <br /> o'O Oo� <br /> Land Use: Date: <br />