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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> and/or Pre-Application Form Survey sionof w Survey: $ $500+$ 0. <br /> 1 I pp Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner: J /110 7 {iV Gc <br /> / w a <br /> Address: I l 3'�f'/ ��1 I S/✓.Jer 1 Sr ^-fi n e S B <br /> Jf 6'ldr 3 / Phone: <br /> Orieinal Parcel Informati1on f� (, 9-) <br /> Parcel Ill#: lJ J ] �o�" b 1— > w Section I Qa Township ( Range � <br /> b <br /> Original Description(or attach copy): .See A*:Ll�'�" p <br /> 7 <br /> Current Zoning: Floodplai Wethm s Y <br /> e Lake/River Classification: l Name of Water Body: <br /> New Parcel Information j <br /> Proposed New Legal <br /> Deescnpti and Parcel Size: f J l� �l 5116 <br /> ��-r� L <br /> Acres: C �r <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: F3`-1`\ zj �I Ott <br /> Proposed access to public waters to be provid Y : k W10rtA`g <br /> d <br /> If yes,describe access: m <br /> A <br /> Signature of 9irrer: Date: <br /> ➢ Does parcel meet Zoning Requiremes? Yes No d <br /> o J <br /> ➢ Does parcel require a Survey? Yes No n <br /> �T 0 <br /> Permit application fees submitted? 13Amount$ Jt/' Dc) Receipt# <br /> m <br /> t" ❑ Reconciles with Real Property Lister Yes No Date: 't <br /> m O <br /> a W <br /> If not,explain: <br /> A � <br /> 0 <br /> c � <br /> w <br /> A licationn::, A proved Denied Reason for Denial: CSU Nei1 of g iwc hq (c 611 <br /> �cX v S ludot.�, cd <br /> Land Use: Date: �U lV <br />