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Burnett County Subdivision Permit Application Fees(mint accompany form): <br /> and/or Pre-Application Form Subdivisi0nw/o survey: $10.00 <br /> n pP Subdivisionw/Survey:$100.00+w.00/lot <br /> Owner: C /J CrC04/V l�-& <br /> r� �/ A <br /> Address: .t)gq Q dLo 36 n 3 <br /> Phone: <br /> 7"0L_100 OtivInalParcelInformatio�n/ '/ <br /> Z Z'7- �/ Township Rangel7✓V <br /> Parcel Identification#: 6L)G�- `/ d2- x/00 Section � <br /> Original Description (or attach copy): flu yq Stu 114.1 — t <br /> A <br /> z <br /> a <br /> Current Zoning: UUZ Floodplain(j)N:N: Wetland Y A <br /> Lake/River Classification: <br /> GM55 3 Name of Water Body: W000 lel VZ)C, <br /> New Parcel InformatiLon�,,, <br /> Proposed New Legal Description and Parcel Size: ed„1 <br /> Acres: ��• 85 3 <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary on p requirements.) <br /> tl ,I <br /> Proposed access to public road: 6 L C> 35 Oa <br /> 0 <br /> m <br /> Signature of Owner: Date: <br /> 0 <br /> ➢ Does parcel meet Zoning Requirements?____y0& No P <br /> 0 <br /> ➢ Does parcel require a Survey? Yes No <br /> p/ 0 <br /> ➢ Permit application fees submitted? ❑ Amount$ 130,d Receipt# O b <br /> A <br /> ❑ Reconciles with Real Property Lister Yes No Date: o <br /> a Q, <br /> A <br /> R If not,explain: <br /> o � <br /> JJ <br /> Application: Approve / Denied Reason for Denial: <br /> o <br /> "t 0 <br /> Land Use: Date: - 612 6 <br />