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Burnett County Subdivision Permit Application Fees(m st accompany form): <br /> and/or Pre-Application Form Subdivi ionwloSurvey: $10.00 <br /> Subdivi ion w/Survey:$100.00+$15.00/lot <br /> Owner: _ 4'A'7- 7�14nea/ <br /> Address: 9 9 z- <br /> B <br /> �1/la�l , �� �yg�Z Phone: o <br /> 4 0 9-3333-o/5a� Original Parcel Information p, � <br /> Parcel Identification#: ff&9-3T3,3-QZy00 Section �3 Township /N/ g Ran e & w <br /> #0/$-333 -97-100 o0 <br /> Original Description or attach copy): Al w $E /V kV <br /> OLA/d 5 K/ N 141 <br /> Current Zoning: OAJZOt✓ Floodplain YWetland ] /N _z-_Lake/River Classification: Nammee of Water Body: J <br /> C✓ <br /> New Parcel Informat^ion� <br /> Proposed New Legal Description and Parcel Size: __ 3 <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: — A;0/_tRtn V lepule( <br /> Signature of Owner: Date n <br /> J <br /> D Does parcel meet Zoning Requirements? Yes <br /> No O <br /> ➢ Does parcel require a Survey? Yes <br /> No <br /> Permit application fees submitted? ❑ Amount$ l Q_ (� Receipt# �a c <br /> 3 <br /> 9 <br /> C <br /> ❑Reconciles with Real Property Lister Yes No Date: <br /> ° 00 <br /> z <br /> a If not, explain: wry <br /> 1,,1 <br /> (a <br /> w WW <br /> Aw <br /> W . <br /> ' do <br /> W �Application: CpprovedDeni ed Reason for Denial: <br /> 00 <br /> a <br /> Land Use: ��{ 6r1� �✓�1 i fie e Date: o 7 <br /> U <br />