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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.00110fi <br /> and/or Pre-Application Form Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner: e>A�i2F3ARAL-ay--i rj . <br /> b <br /> Address: 610 (-a , ��1 00Lf �. <br /> 71s - 86 - -737a /�v <br /> Eau C(ICilt'e VUI Sg701 Phone: 1 i5- S(pG -ooGj(C( t <br /> Original Parcel Information Q� <br /> o28-4% t(o -o Z- g o n "� � <br /> Parcel ID#: O 213-4 t 1 (o -0 3 - �i 1 o Section i (o Township 40 Range 14 J <br /> Original Description(or attach copy): A�T-T-A c L\ <br /> O <br /> �GE �o�oi7io�Ja� v5 E T'E4zr-4 ,•r ( O 5B A <br /> ti <br /> Current Zoning: 2tz-25 Floodplain NO Wetlands Y&.Me <br /> Q <br /> .m°. Lake/River Classification: Name of Water Body: � <br /> t_ <br /> New Parcel Information �W <br /> P <br /> Proposed New Legal Description and Parcel Size: <br /> fi <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> i <br /> Proposed access to public road: 11ct�5 EA5E:-m =,J-r- 7Tz%y ATG ( A5 SLIa <br /> Proposed access to public waters to be provided Y61- <br /> If yes, describe access: d <br /> A <br /> Signature of Owner: _ Date - ----\1e/d W <br /> a <br /> b i Duespat-cet'tiiee'tZonirgRegaleetsents? Fes NO - <br /> O <br /> ➢ Does parcel require a Survey? Yes No <br /> A <br /> _ o <br /> D Permit application fees submitted? ❑ Amount$ 5 D O Receipt# <br /> e <br /> ro <br /> t` ❑ Reconciles with Real Property Lister Yes No Date: <br /> I r' <br /> �0 If not,explain: R , <br /> o .L = <br /> 6c6 <br /> Applica : Approved nied Reason for Denial: Ie4&v <br /> W <br /> W k• GF ,S SANG OG/As/b�• O <br /> Land Use Date: <br /> 04 <br /> o'F 14jj Pf r Cir . ,OPr�/tf -#:: 1658" <br /> Q�n,G'rsA ✓e 0 rte. n8l � lgirS�r�/J 1S <br /> Ne Io l� <br />