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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: $10.00 <br /> and/or Pre-ApplicationForm Subdivision w/Survey:$100.00+$15.00/lot <br /> Owner: <br /> Address: �L&(r(q 1"i"s 3 <br /> 011 65k/ hTL Is 9�3 Phone: o <br /> Original Parcel Information <br /> UILl - as 15- 0 <br /> l- 300_(7) 666 <br /> Parcel Identification#: GJ`1- ��IS-Oa `YUO Section _Township 3 U Range �� C <br /> 6� <br /> Original Description(or attach copy): <br /> r?w- � cec /S T�fS" � l5 ( J <br /> 9 <br /> 9 Current Zoning: _ Floodplain Y/N: Wetlands Y/N: I✓ <br /> n <br /> Lake/River Classification: Name of Water Body: N� <br /> New Parcel Information <br /> f� CTC <br /> Proposed New Legal Description and Parcel Size: lafpw <_�ee � <br /> S <br /> Acres: aoypy <br /> o�• 5� s <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: �V ri <br /> Proposed access to public waters to be provided nS <br /> If yes,describe access: p <br /> m <br /> A <br /> Signature of Owner: Date: <br /> SLI <br /> o ➢ Does parcel meet Zoning Requirements? Yes No <br /> ➢ Does parcel require a Survey? YesNo <br /> p� n <br /> Permit application fees submitted? ❑ Amount$ J 0, o C) Receipt# lcob 'g <br /> 'fl <br /> C <br /> A <br /> r" ❑ Reconciles with Real Property Lister Yes No Date: # <br /> If not,explain: <br /> Q / W QJ <br /> C " <br /> � L � O <br /> Application: Approved / D nied Reason for Denial: tv//7( / pA�o"� <br /> GL2Sa t -fes c uaA� Otic t.�EE I - - 0 <br /> Land Use: Date: <br /> S— -O�) <br />