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Burnett County Subdivision Permit Application Fees(must accom any form): <br /> and/or Pre-A lication Form Subdivision wlo S rvey: $10.00 <br /> hp Subdivision w/Su vey:$100.00 $15.00/10t <br /> Owner: 6T2d2 I t 16y(Uk. & <br /> Address: P6, 136X <br /> '' '' 11 /'jun o/p 3 <br /> �1�LQ/Y�l 0j; 5'I2S /� Phone: 966_ .;' 7 0 <br /> Oriainal Parcel Information <br /> DIS-33g8-OZ�Do �,,,,�/� me aJ 51J <br /> Parcel Identification#: _0/8' 352 — dJ0section 4 Township .WN 1ange f <br /> Original Description(or attach copy): (C) l — I Y"' <br /> /Q td v (0o'1 P ggo-yq l <br /> > A 9 1 LA M-r.V+0C ir bonj,e( QJ A4, <br /> CA <br /> Current Zoning: WJ 20N2 Floodplain Y N Wetlands Y& C <br /> Lake/River Classification: Name of Water Body: S <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: e 4 Leff k <br /> 30014 w1,04 F.r df fA of L>/ /V-,f <br /> Acres: /�• �� <br /> (If parcel is to be surveyed, provide preliminary map. See attached floor preliminary map requ rements.) <br /> Proposed access to public road: /1 /d <br /> d <br /> Signature of Owner: Date: <br /> o > Does parcel meet Zoning Requirements. Yes No J <br /> Q > Does parcel require a Survey? =Yes Na <br /> n <br /> 0 <br /> > Permit application fees submitted? ❑ Amount S Receipt 96)"739 <br /> 9 <br /> A <br /> ❑Reconciles with Real Property Lister Yes No Date: Oda <br /> a <br /> If not,explain: w w <br /> a w <br /> o � <br /> Application: Approve Denied Reason for Denial: o° J <br /> c o <br /> Date: <br /> Land Use: "�d`Q <br />