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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: $10.00 <br /> and/or Pre-Application Form Subdivision w/Survey:$100.00+$15.00/lot <br /> an d� <br /> Owner: rr � r Q �I\/ Y P.r1 o r S,".&' YfCv' <br /> Address: �FiE7o11 a9 3TC' AUC.cI Celt `715- 566--0I0.Z, s <br /> Frederl c VV L . 5 TMJ 37 Phone: ? <br /> Original Parcel Information "J_ <br /> Parcel Identification#: ��iF' IS-33 - 01700Section 33 Township 37 Range <br /> Original Description(or attach copy): TH e_ N 1/v/ I�4 O � t Lk4—. NUJ Yf <br /> S e<A,%onTR IS \AZ ° <br /> 0 <br /> A <br /> 9 <br /> 9 Current Zoning: Ai--I _ Floodplain Y/N: Wetlands Y/N: <br /> Lake/River Classification: 1V Name of Water Body: IA <br /> New Parcel Information y <br /> Proposed New Legal Description and Parcel Size: L o t 11 o� C <br /> CIL <br /> SV.r V tet/ mat, RpV;�_N 1-to to <br /> Acres: --5� A C.r't?S <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminaryy map requirements.) <br /> Proposed access to public road: r f tV n \ �f� l VQ '! om { �q �OW r1 foq�. <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: 43 ( 07 <br /> t7 <br /> A <br /> Signature of Owner: Da <br /> Date: <br /> �/ G b <br /> e ➢ Does parcel meet Zoning Requirements? Yes No <br /> C <br /> ➢ Does parcel require a Survey? Yes NO <br /> Permit application fees submitted? ❑ Amount$ Receipt# <br /> 0 <br /> b <br /> e <br /> ❑ Reconciles with Real Property Lister Yes No Date: D <br /> o � <br /> a .. <br /> A <br /> If not,explain: <br /> n <br /> 0 <br /> a <br /> m <br /> Application: Approve / Denie Reason for Denial: �Z�N 2 (,�P1i(t l� I /QACi <br /> Land Use: <br />