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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 wlSurvey:$100.00+$i5.0011ot <br /> Owner: GC(CA , o� i Y ll S, d' /nom <br /> // O� <br /> Address: f/ S U ti <br /> Phone: O 3� <br /> Original Parcel Information <br /> _ od 7v° <br /> Parcel Identification#: Section / Township �� /Range <br /> Original Description(or attach copy): <br /> 0 <br /> A <br /> a � <br /> c' <br /> m Current Zoning: -3 Floodplain Y/N: /'f/a Wetlands Y/N: '77- <br /> Lake/River <br /> Lake/River Classifigation: Name of Water Body: ,-----.. <br /> 4 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: S e P QQ Q <br /> Acres: o <br /> 7 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> d <br /> Signature of Applicant: Date: <br /> ➢ Does parcel meel Zoning Requirements? Yes <br /> e Y Does parcel require a Survey? Yes P�) <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt # <br /> e <br /> m <br /> '7 �? `b <br /> � <br /> El Reconciles with Deal Property Lister Yes No Date: p o <br /> 06 R) <br /> R If not,explain: <br /> o <br /> 936 <br /> d <br /> Applicati Apptove / Denied Reason for Denial: c e <br /> O a <br /> Land Use: Date: '-3/ y� <br />