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Subdivision Permit App Fees(must accompany f <br /> Burnett County <br /> and/or Pre- Application snba;v;sion w o snry 50.00 <br /> Application Form Survey of ExisfingPazcel: 50.00 &f- <br /> Subdivision w/Survey: $20000+ <br /> Owner: ry Amt SO� . $SO.000ot <br /> Address: �T/S 7DWNT/tel% <br /> � f (Jf/2C g <br /> Phone: 7/17-' y� <br /> ��( � � Old OO ri mal Parcel Information <br /> Parcel ID#; — 0 <br /> C) 4 700 - �tSection3 <br /> Original Description(or attach co /� Township Ran e <br /> IM <br /> Inq� ll�t��SGr� g I J <br /> ae'- d s <br /> copy): �ei <br /> O <br /> 5 <br /> Current Zoning: "� <br /> Floodplain x9;y <br /> Lake/River Classification: Wetlands Y � <br /> N—� <br /> — Name of Water Body: <br /> New Parcel Information R <br /> Proposed New Legal Description and Parcel Size: \ <br /> (If parcel is to be suAcres: ap(e`ed,provide A y <br /> Preliminary map. See attached for relimina <br /> Proposed access to public road: pl -b 1,(- P rS map requirements.) <br /> --JLC 1C0� � -Ct iJ <br /> Proposed access to public waters to be provided YQ <br /> If yes, describe access: IUA <br /> k t7 <br /> m <br /> Signature of Owner: m <br /> S % <br /> Date:Does parcel meet Zoning Requirements? <br /> �5 O � <br /> � Yes <br /> on° Does parcel requ';•e a Survey? No <br /> Yes No `) <br /> Permit apPlication fees submitted? <br /> Amount$'50 Z) <br /> _ ip1V1�7 g <br /> Reconciles t# <br /> with ReceReal Property Lister ProP e - fl <br /> c e <br /> If not,explain: ye N° Date: m <br /> o <br /> yCX% C d <br /> y12 <br /> Cq W <br /> Application: pproved eniedd <br /> Reason for Denial: � <br /> �. <br /> Land Use: �l o <br /> Date: Aj <br />