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Burnett County Subdivision Permit Application Fees(mug accompany form): <br /> Subdivision w/o Survey: $10.00 <br /> and/or Pre-Application Form Subdivision W/Survey:$100.00+$15.00/lot <br /> Owner: .4�1i�Ee� .4 v1� / e`iAt /?,/ mit/ <br /> Address: 33// A4e,-11S <br /> r1 9<71 337.y-off' <br /> Phone: 9e <br /> C1J <br /> Ori¢inal Parcel Information <br /> Parcel Identification#: OIW.2Zflo V/ 71:10 Section le-1 Township 35s, Range LSA <br /> Original Description(or attach copy): - .(lp t7lt /{/!1 T %/ orye Ad' p <br /> s <br /> %WT <br /> 9 �iq�4Gf� �S Le �Nrri✓�� /d4alSy�, kJlr CpN/tl�f/ <br /> m Current Zoning: Floodplain YIN: Wetlands YIN: <br /> o <br /> Lake/River Classification,-V'6yd�J `O% r3zme of Water Body: 41-711 Iry t l/- /w <br /> 4 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: �6�rvE i✓3�D 3� s <br /> N <br /> (If parcel is to be surveyed provide preliminary map. See attached for preliminary map requirements.) <br /> J <br /> Proposed access to public road: l�C"� <br /> w s <br /> Signature of Owner: ( � Date: r-ly <br /> Does parcel meet Zoning Requirements? Yes No <br /> 6 ➢ Does parcel require a Survey? Yes No <br /> w n <br /> e <br /> Permit application fees submitted.? ❑ Amount$ 0 ( Receipt# 9 <br /> 9 <br /> C <br /> s <br /> eJ Reconciles with Real Property Liste Yes No Date: �.d C)l <br /> CL y <br /> a <br /> If not,explain: 4 <br /> CL <br /> w %3 <br /> S <br /> Applicata Approved / D led Reason for Denial: <br /> v <br /> n <br /> Land Use: Date: ��' <br />