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Burnett County Subdivision Permit Application Fees(must ae(Dmpany form): <br /> and/or Pre-Application Form Subdivision o Survey: $10000 <br /> Subdivision w Survey:$100.00+$15.00/lot <br /> Owner: is <br /> ,o ro <br /> Address: r t� 3 <br /> %G 7 - <br /> o 5' O Phone: .1,97"Ire/ <br /> l�1 <br /> Or' •nal Parcel Informatio <br /> Parcel Identification#: -d Section o nship 3 RangeI-T-- <br /> Original Description(or attach copy): !✓ C <br /> 9 <br /> e Current Zoning: /Y o2 Flo dpla q YIN: Wetlan s Y : ~ <br /> Ill... re <br /> Lake/River Classification:,�341;6r 4X' ame of Water Body: <br /> 4 <br /> ew P ircel Information <br /> Proposed New Legal Description and ParcelSize: -Q.041ii i 2 ';� 'ec-ff <br /> a� E'r !a ` �tI <br /> 6,/es-r YA .d coir% aM O.os-a: Z <br /> Acres: - <br /> .2 O } <br /> (If parcel is to be surveyed,provide prelim' aryap. See attached for pr!I urinary maprequirements.) <br /> Proposed access to public road: <br /> d <br /> m <br /> Signature of Owner: Date: <br /> i <br /> ➢ Does parcel meet Zoning Requireme s? Yes N <br /> J <br /> ➢ Does parcel require a Survey? Yes N <br /> 0 <br /> ➢ Permit application fees submitted? ❑ Amount$ U Receipt % 9 <br /> C <br /> rt <br /> Ll Reconciles with Real Property Lister Yes No ate: c <br /> a <br /> XIf not,explain: <br /> 0 <br /> a yj <br /> y <br /> Applicatio Approved / nied ReasoE for Denial: <br /> to <br /> Land Use: E a e: 3 G <br />