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Burnett County Subdivision Permit Application Fees(must accompany forth): <br /> and/or Pre-A lication Form Subdivision w/o Survey: $10.00 <br /> -� PP Subdivision w/Survey:$100.00+$15.00/lot <br /> Owner: VC Y't'r 1 Afa bl Gr" ke0o"-d <br /> Address: 22185 t4 Infer 5i62 5r led 70 <br /> //�� R , ��I,h', �A/ �jlla�f/ I'I (�� yy ' ,/ �N /16- 3 <br /> `� r^l' , YYI 47D"lU VVtt�7iM I VV Phone: b09'ZN7/ o <br /> O/rieinal Parcel Information �, <br /> Parcel Identification#: OYLZ J3to�Q��+l k Section�Township jAN( Range /go/ Q <br /> Original Description (or attach copy): 2— Ex e 5/)-) V/.,5 1/0 '7c2— 0 <br /> E <br /> a <br /> A <br /> 1 <br /> a <br /> Current Zoning: Floodplain Wetlands <br /> Lake/River Classification: Name of Water Body: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> Vy as e6 bpi <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary ,m�a/p.��S--ee attached for preliminary <br /> —maprerequiremenits�.)/ <br /> Proposed access to public road: i t LCl ,NU.I.LA 1W — (�MA�ri�I /CS VV <br /> y d <br /> Signature of Applicant: `� sut. _ Date: o G <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> 0 <br /> ➢ Does parcel require a Survey? Yes No <br /> / o <br /> ➢ Permit application fees submitted? ❑ Amount$l`y S, 0 U Receipt#JQ?D8 3 <br /> 9 <br /> C <br /> R <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> CL p <br /> $ If not,explain: Q) <br /> 0 <br /> w <br /> Application: Approved Denied Reason for Denial: <br /> i <br /> Land Use: Date: <br />