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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: $50.001le <br /> p Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner: j l Yrl �l eP SL' I JG""P'� q+erS Un <br /> /77aleg5u -ee k0A <br /> Address: '53L''",, II- �ldr` 0�d wZI'S k,- IA)I -S ! g93 0 <br /> weWk/- wZ 5LI 9073 Phone: <br /> � ��nn Original Parcel Information C�1J <br /> Parcel D)#: O��'-3`Yva,-Oa-I DO Sectiona' <br /> c� Township Range 1 �7 � <br /> Original Description(or attach copy): i/� n)LQ 5U<) C <br /> e <br /> Current Zoning: Un Zoned Floodplain Y Wetlands Y, ) <br /> eLake/River Classification: NI Name of Water Body: N/'q- <br /> New Parcel Information (N <br /> Proposed New Legal Description and Parcel Size: 6 <br /> Ella Gila 00 SLO - IDR <br /> w 'I a E VDL tj W S lA) — to A- Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Pe V-I CO, r2 A <br /> Proposed access to public waters to be provided Y/N: A)�� <br /> If yes, describe access: m <br /> A <br /> Signature of Owner:/tz' J Date: <br /> S] ➢ Does parcel meet Zoning Requirements? Yes No <br /> ➢ Does parcel require a Survey Yes No n <br /> � <br /> Permit application fees submitted? ❑ Amount$ 't� <br /> 7 v_� , D D Receipt# <br /> e <br /> ❑ Reconciles with Real Property L' er Yes No Date: 2 <br /> ryy If not,explain: <br /> m <br /> o � <br /> a � <br /> y <br /> Application: pproved / De ' d Reason for Denial: <br /> c <br /> Land uae: <br /> 0 <br />