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Burnett County Subdivision Permit Applicaiio n Fees(must Accompany form): <br /> Subdivisiol w/o Survey: $10.00 <br /> and/or Pre-A pl•catl n Form Subdivisio w/Survey:$100.00+$15,0011ot <br /> Owner: .� I <br /> Address: -71 L (Al <br /> `7 l Poe: <br /> O ina Parcel Information lJJ <br /> Parcel Identification#: U Section . Township Range ! .� <br /> Original Description(o a facfi coty . G� SCG <br /> O <br /> A <br /> > �1 <br /> 9_ Current Zoning: —J FI odpl in Y(N) Wetlands Y' yel <br /> o Lake/River Classification: ame of Water Body <br /> New ParcelInformation (- <br /> Proposed New Legal Description and Parcel Size: <br /> o <br /> ll � <br /> res: l <br /> (If parcel is to be surveyed,provide prelim nary map. Seeched r r liminary ma requirements.) <br /> 3 <br /> Proposed access to public road: 77 Y70 <br /> Proposed access to public waters to be provided /N: <br /> If yes,describe access: t7 <br /> m <br /> A <br /> J� <br /> Signature of Owner: Date: � <br /> tc.7 > Does parcel meet Zoning Requirements? Yes Ao O <br /> > Does parcel require a Survey? Yes Q.o <br /> n <br /> Permit application fees submitted? D Amount$ /Q' bi I Rece ipt# q5pe3 °g <br /> c <br /> m ❑ Reconciles with Real Property List Yes No Do te: 1 V 7 <br /> a O o <br /> If not,explain: w <br /> CL 4- <br /> JJ W <br /> 0 0 <br /> Applicatio Approved / nied Reas n fo Denial: o <br /> Land Use. .h late: <br />