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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form Subdivision w/o Survey: $10.00 <br /> pp Subdivision w/Survey:$100.00+$i$.00/lot <br /> Owner: <br /> Address: <br /> Phone: <br /> U) <br /> Orieinal Parcel Information <br /> OJftoo )) <br /> Parcel Identification#: 0 d� `{t'�'" — 03 Section Township Township Q Range <br /> Original Description (or attach copy): �� -e M a h <br /> O <br /> 0 <br /> m <br /> a <br /> m Current Zoning: Floodplain WN: 4ZO Wetiands Y/N: <br /> Lake/River Classification: Name of Water Body: <br /> 4 <br /> New Parcel Information L-) <br /> A / F- <br /> Proposed New Legal Description and Parcel Size: z <br /> 6n <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> 6 d <br /> Signature of Applicant: ZZV7__� Date'/ff _o <br /> ➢ Does parcel meet Zoning Requirements? Yes n,00-0 Does parcelrequire a Survey" Yes f1 <br /> ➢ Permit application fees submitted? ❑ Amount$ D, 0 U Receipt# a 1 3V <br /> E <br /> m <br /> r <br /> ❑ Reconciles with heal Property Lister Yes No D e: <br /> g I[not, explain: , <br /> a <br /> � S <br /> i <br /> C � <br /> Application: Approve / Denied Reason for Denial: uJ� <br /> 0 J <br /> Land Use: Date: p Q <br />