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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form Subdivision w/o Survey: $10.00 <br /> PcP Subdivision w/Survey:$]00.00+S 1 S.w/lot <br /> Owner: (Q ` t <br /> Address: �' x 3�8 <br /> t T �/�f ✓J6D� Phone: 9Q'Y a?D/aP— e <br /> �1 c� Original Parcel Information t/ / <br /> Parcel Identification#: �3d'S /Zy'd /t7 d —/Section Township t�N Range <br /> Original Description (or attach copy): Lp7'-- to <br /> V 13 159 1 <br /> CurrentZonin R3 <br /> w g: Floodplain Y(9 Wetlands Y,O <br /> Lake/River Classification: Name of Water Body: <br /> 4 <br /> New Parcel Information P <br /> c <br /> Proposed New Legal Description and Parcel Size: 02 571-)/tJ <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: E,'!ry.p eqL usr,4 4 adoMy <br /> d <br /> Signature of Applicant: yea Date: 6 C <br /> ➢ Does parcel meet Zoning Require nts? s No <br /> 0 <br /> Does parcel require a Survey? No <br /> (� A <br /> ➢ Permit application fees submitted? ❑ Amount$ 4J DO Receipt# 43 a <br /> 'O <br /> C <br /> A <br /> � <br /> 11 Reconciles with Real Property Lister Yes No Date: p <br /> a <br /> If not,explain: <br /> a �u <br /> pplicatio Approved Denied on for Denial: <br /> a <br /> LandUse: Date: <br />