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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 /> AP Subdivision w/Survey:$100.00+$15.00/lot <br /> Owner: 6G4 / 5 &v <br /> PAddress: <br /> Phone: <br /> �/ Orisinal Parcel Information <br /> Parcel Identification#: �3�`6 /Zy4 11Od Sections Township /�N Range /070 <br /> Original Description (or attach copy): At--/ LIJ� 0 617 fM p <br /> V !3 9 r. <br /> a Ri <br /> ,p <br /> Current Zoning: Floodplain Y6 Wetlands Y, 1�: <br /> Lake/River Classification: Name of Water Body: <br /> New Parcel Information p <br /> Proposed New Legal Description and Parcel Size: 1 <br /> 11 �5/ t S <br /> azoAcres: (Zr' <br /> 1 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: E,E'jl r17.0 e91eN„sh04 stdi, <br /> Signature of Applicant: Date: 111216C <br /> ➢ Does parcel meet Zoning Requirement . Yes No <br /> 0 <br /> ➢ Does parcel require a Survey? =Yes No <br /> ➢ Permit application fees submitted? ❑ Amount$/ , 00 Receipt <br /> e <br /> i9 <br /> ❑Reconciles with Real Property Lister Yes No Date: o, <br /> a <br /> If not,explain: <br /> a <br /> Application. Approved )Denied Reason for Denial: p <br /> C7 <br /> Land Use: Date: —��— t7 <br />