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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 /> -} Subdivision w/Survey:$100.00+$IS.()0liot <br /> Owner: 16-- PP W <br /> Address: Wq 1 q I 0&_-K L&re_ 1Qd 79y <br /> c� 3 <br /> TIJC!J�� I)J; 5LWI /11Lt2 0 d Pee: 7/5' 36- y7�ol Z <br /> 0 <br /> p Orieinal Parcel Information / <br /> Parcel Identification#: 6 2 9417 6438X Section363O Township LIW Range l yw <br /> Original Description (or attach copy):6/ 3 l7 <br /> 5 0 <br /> a <br /> y <br /> Current Zoning: IQJ n, Floodplain I' : Wetland&Y N: S <br /> e J <br /> Lake/River Classification: (n , - ' / Name of Water Body:L j <br /> S <br /> New Parcel Inforrmation 3 <br /> Proposed New Legal Description and Parcel Size: CEJ/-)7 <br /> ('V'rLoy l • Ar Ort<s-e I`% f'J 0U" ht•- /V~f4 <br /> Acres: 9 `/3 <br /> (If parcel is to be surveyed,provide preliminary map. See attachedfor preliminary map requirements.) <br /> Proposed access to public road: 7'd I L L Road <br /> Signature of Applicant: Date: d( 2? 06 A <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N <br /> 0 <br /> �• ➢ Does parcel require a Survey? Yes No <br /> Permit application fees submitted? ❑ Amount S _'�0 O D Receipt# -1 LIC/ 9 <br /> A <br /> ?f <br /> 11 Reconciles with Real Property Lister Yes No Date: u <br /> a <br /> e If not,explain: oa <br /> t <br /> W <br /> Application: Approve / Denied Reason for Denial: W <br /> Land Use: Date: Q, <br />