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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> aPre-Application Form Subdivisionw/o Survey: $10.00 <br /> and/or Pre-A <br /> PP Subdivision w/Survey:$100.00+$15.00/lot <br /> Owner: — (C,` a ke <br /> Address: <br /> Phone: 0 <br /> z <br /> Orieinal Parcel Information Cly <br /> ,�- <br /> Parcel Identification#: o d y `/tr 03 Section,�/� Township Range <br /> Original Description(or attach copy): S� a�-�J -A A LF o <br /> e <br /> A <br /> m Current Zoning: Floodpiain Y/N: 4 Wetlands YIN: y a-CA-e- <br /> � <br /> Lake/River Classification: Name of Water Body: <br /> 4 <br /> New Parcel Information L� <br /> l <br /> Proposed New Legal Description and Parcel Size: <br /> //h n <br /> Acres: t V 1 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements) <br /> 5 <br /> Proposed access to public road: <br /> 6 <br /> Signature of Applicant: Date: <br /> 00 <br /> ➢ Does parcel meet Zoning Requirements? Yes o <br /> N � <br /> r Does parcel require a Survey? Yes Vu <br /> n <br /> ➢ Permit applicatioy fees submitted? ❑ Amount$ D• D() Receipt# (5 0 ) <br /> e <br /> r <br /> El Reconciles with Real Property ListerYes No D e: <br /> CL O o <br /> If not,explain: �W <br /> o <br /> N <br /> 1 <br /> Application: Approjve / Denied Reason for Denial: G o <br /> W 4� <br /> c ;1 <br /> Land Use: Date: 7-31,06 00 <br /> G+ Q <br />