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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o survey. $50.00 <br /> and/or Pre-Application Form Survey of Existing Parcel: $50.00/1o+ <br /> PP Subdivision w/Survey: $200.00+$50.00Aot <br /> Owner: C-V r Leo- y <br /> A <br /> Address: (? 0• 604 506 /l"Y 11 t 2,007 <br /> 6 m.o. i smaG t b✓1 S4-84O Phone: 7/S 463 5337 ' <br /> Uj <br /> Original Parcel Information S2� <br /> Parcel ID#: 0 4 2 Z 5 34 0 7 -7 oo Section 34- Township 38 Range 19 J <br /> Original Description(or attach copy): Lc•r 3 CSM VOL Zl , 17 /83- 7$-7 <br /> m <br /> c Current Zoning: r21Z.I Floodplain Y/N: 'Wetlands Y/N: <br /> 0 Lake/River Classification: Name of Water Body: W60-p> LAK E <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: D i Ji DS til S-ri a G Lor 1 NTO (� <br /> Tot1i) PA r1C—LS By GSM <br /> Acres 1 Z �v <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: ..8_)L it AS EM sCWr` <br /> Proposed access to public waters to be provided Y/N: tJ1,4 <br /> If yes,describe access: d <br /> / A <br /> +�, /�on Sid <br /> Signature of Owner: Date: <br /> ➢ Does parcel meet Zoning Requirements? No <br /> DO <br /> ➢ Does parcel require a Survey. Lount <br /> Noso �PP fD IJ ReceiptPermit a lication ees submitted. ❑ $ � <br /> T <br /> A <br /> 1 <br /> t ❑Reconciles with Real Property Lister Yes No Date: ?t <br /> c o <br /> o If not,explain: 9) <br /> o � <br /> a � <br /> U) <br /> 0.1 <br /> Application: roved / enied Reason for Denial: Q <br /> J <br /> C> <br /> Land Use: Date: <br /> r <br />