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Burnett County Subdivision Permit Application Fees(mustaccom any form): <br /> and/or Pre-Application Form Subdivision w/o S rvey: $IO.Oq <br /> Subdivision w/Su vey:$100.00 t$15.00/lot <br /> Owner: tu-C.& <br /> Address: P6. /JR b X 612- <br /> A <br /> p 3 <br /> Phone: o -S-07 0 <br /> Q/� 3��8-(J27Do OricinalParcel Information <br /> Parcel Identification #: 332-9— 6 ection ,29 Township -WA/ e ang <br /> Original Description (or attach copy): l - 5 Uj /V 4 e <br /> ae.c( V P 4qo-qq <br /> > of <br /> t <br /> 7E At AUrn-114 <br /> Current Zoning: Un/201J t d Floodplain Y6 Wetlands Y <br /> Lake/River Classification: Name of Water Body: c/Y-ernA� <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: e- 5-m 4 LefS <br /> 300`; >vfoc Fo- df fA of L,f /L)-,r <br /> Acres: /lD• 7 <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: / ��Z�-I /-/ Aez-el . <br /> 0 <br /> Signature of Owner: Date: y` <br /> Does parcel meet Zoning Requirements? Yes No <br /> N <br /> 0 <br /> Does parcel require a Survey? Yes No <br /> ao <br /> Permit applicalion Dees submitted? ❑ Amount 5n <br /> Receipt # � <br /> y 7 Reconciles with Real Property Lister Yes No T <br /> c Date: a <br /> A <br /> If not, explain: <br /> 0 <br /> , <br /> Application: Approved / Denied Reason for Denial: <br /> Land Use: Date: <br />