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Burnett County Subdivision Permit Application iccompanyform): <br /> Subdivision w/o Survey: $10.00 <br /> aned/or /Pre-Application'/Form /� Subdivisio w/Survey:$100.00+$15.00/lot <br /> p <br /> Owner: 1 t�[ / m r kegA W — k fl'pe� V05C,L E <br /> Address: Pd.�'aoq1b 1656 132�d c N� //NE g X49_ZyyB 3 <br /> �l(ZP�YII U!i 57D9Z I�LcUIUe, rnN ��Phone: 6 z-7s5-1o�35 <br /> �N <br /> b18-3335-65 Original Parcel Information �7 <br /> Parcel Identification#: 01$'33�6- 6536OSection 35 Township tv Range <br /> Original Description (or attach copy): Q U- 61C "T 16 a- P.1-4_4 <br /> k o - q h'bbe-t-T dS� <br /> > flea Qat` G. L. a <br /> Current Zoning: I,(h1 LOme.ot- Floodplaim N: Wetlan <br /> Lake/River Classification: CL?q 76 I Name of Water Body: C&Irn4k_121 <br /> A <br /> New Parcel Information n g� <br /> Proposed New Legal Description and Parcel Size: C151m S <br /> Acres: M <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary ma 3 requirements.) <br /> Proposed access to public road: 5T' r b <br /> d <br /> m <br /> Signature of Owner: Date <br /> G <br /> > Does parcel meet Zoning Requirements? Yes No <br /> �• > Does parcel require a Survey? Yes NU <br /> � p o <br /> > Permit application fees submitted? ❑ Amount S 5D,C)D Recei t# <br /> e <br /> A <br /> Reconciles with Real Property Lister Yes No Date: <br /> 11 p <br /> If not,explain: <br /> arW <br /> N 1WR <br /> vl <br /> c <br /> Applicatio Approved / enied Reason for Denial: <br /> W <br /> Land Use: Date: - y' 7 <br />