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Burnett County Subdivision Permit Application Fees(must accompany fonn)L <br /> and/or Pre-A licat' n Form Subdivision w/o Surve $Io.00 <br /> pp Subdivisio w/Survey:$I 15.00/lot <br /> Owner: <br /> g� Y ea - � <br /> Address: 7 <br /> Phone: <br /> Orieinal Parcel Information <br /> Parcel Identification#: 03a' S 3,)C/' 03—/Q() Section P9 Township Range JN <br /> Original Description(or attach copy): L,-) SGS <br /> O <br /> e <br /> s Current Zoning: _ Floodplain Y Wetlan Y _ <br /> Lake/River Classification: Name of Water Body: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: ht W V.1 SL-) 5-F eC.a q N <br /> W Acres: (..7 1'C <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary ma requirements.) <br /> Proposed access to public road: C2( -1FOwl. �CJ� From <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: C <br /> m <br /> A <br /> Signature of Owner: Date: <br /> o ➢ Does parcel meet Zong Requirements? Yes No 1 <br /> � O <br /> ➢ Does parcel require a Survey? Yes No J <br /> n <br /> Permit application fees submitted? ❑ Amount$ Recept# 3 <br /> r� e <br /> ❑ Reconciles with Real Property Liste Yes No Date: 1 <br /> 0 <br /> nj <br /> � If not,explain: IVfJJ <br /> nAD 30 <br /> o � <br /> CL (� <br /> N r' <br /> Application A r enied Reason for Denial: I O <br /> W <br /> a <br /> Land Use: Date: e d <br />