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Burnett County Subdivision Permit Application Fees(mast accompany form): <br /> and/or Pre-Application Form Subdivision w/o Survey: $10.00 <br /> 'j' � j, AP Subdivision w/Survey:$100.00+$15.00/lot <br /> Owner: �Jd/��lUy1l z`^ (Y, /t�IU/�Y e�,2/C A/ 646 <br /> Address: W"1 Il +-Lx-K 1 (CKe IBJ /9y /kaxj�t / 7M J`/5,o <br /> Orieinal Parcel Information lT{ <br /> Parcel Identification#: 6)0pp'1136-0MjZ Section `6 Township y0A/ Range /Vn/ <br /> Original Description (or attach copy):6/ 3 5 <br /> f <br /> e <br /> ee <br /> a � <br /> Current Zoning: �fA1C6lL¢ FloodplainY'N: QWetlan/dy(Y/�/N: / �c <br /> Lake/River Classification: (.�[!ay l Name of Water Body: Ul <br /> New Parcel Information �F <br /> Proposed New Legal Description and Parcel Size: e5 o) <br /> Qt/T Cv7S -Ct-( t• 4I��/.�yt.� lV~f4 _ <br /> Acres: J. `/3 <br /> (If parcel is to be surveyed,provide preliminary map. See attachedforpreliminary map requirements.) <br /> Proposed access to public road: 41 LL �OQa <br /> d <br /> Signature of Applicant: Date: d r, 23 66 lg <br /> HOUSES <br /> c ➢ Does parcel meet Zoning Requirements? Yes No <br /> Does parcel require a Survey? Yes No <br /> A <br /> 0 <br /> Permit application fees submitted? ❑ Amount S Receipt# 9 <br /> e <br /> rt <br /> ❑Reconciles with Real Property Lister Yes No Date: j 9) <br /> a <br /> R If not,explain: 00 CK, <br /> 0 <br /> a � <br /> w <br /> Ued ) DenApplication: pprovied Reason for Denial . u1i <br /> w *2 ✓ A , .,— 5� �'�e so� o.A d 0 aCK <br /> be <br /> Land se: Date: O <br />