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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: $10.00 <br /> and/or Pre-Application Form �S�ubbdivisionw/Survey:$100.00+$15A(1/bt <br /> fi <br /> Owner: `JOhd Z`^ 'ry--, <br /> Address: WM I Rx K L&ke- Rd 7 'l �1 `, <br /> W, fie: MI5-1035- yy�l o <br /> Orieinal Parcel Information <br /> Parcel Identification#: 6� 9 <br /> -*1 64380b Sectio/nn 36 Township LMA/ Range <br /> Original Description (or attach copy):6/ 5 7 p <br /> e <br /> A <br /> v <br /> M A <br /> m Current Zoning: 14A Z6ri Q 1d--,, Floodplain Y Wetland&YY N: <br /> Lake/River Classification: ( / Name of Water Body: L60 MCA�W?-: ' <br /> New Parcel Information }}}p <br /> Proposed New Legal Description and Parcel Size: CEJ a) <br /> O ci7'Lv T.S • �� t(ee-<'C-( <br /> Acres: �3 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 41 LL Road <br /> t./ <br /> Signature of Applicant: -L Date: 9/2-7/6 Ir. <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> 0 <br /> ➢ Does parcel require a Survey? Yes No <br /> 0 <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# 9 <br /> e <br /> A <br /> u <br /> ❑Reconciles with Real Property Lister Yes No Date: p <br /> R If not,explain: <br /> o 4L <br /> 'a <br /> h/ O O <br /> Application: Approved / Denied Reason for Denial: JG w� 7a A ( p L)� w ( ) <br /> h- Y 0 p <br /> Land se: be l— Y CsM 8 -a5_3 Date: L01 <br /> i' <br />