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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parcel: S50.00Ilot <br /> and/or Pre-Application Form Subdivision w/Survev: 5200.00+SSO.M%t <br /> Owner: TDI/{/hq k9'Wb_k_, Buyer: <br /> Address: BOX Address: B <br /> 0 <br /> Phone: - �y� - Phone: <br /> J <br /> Ori¢inal Parcel Information <br /> r7l loon <br /> Parcel ID#: 0 -2 yl-/6-35-3 D�aO�eetian_?LTownship 7/At RangeA0 O <br /> Original Description(or attach copy): <br /> A <br /> a � <br /> n <br /> '+ Current Zoning: /l /l oZ Floodplain yeJ ?w` Wetland ] 7c/ <br /> t-1 <br /> Lake/River Classification: Name of Water Body: <br /> New Parcel Information t 3 L( f a 3-a <br /> Proposed New Legal <br /> cDescription <br /> land Parcel Size: 2 C Sm S 8 Lo 41 <br /> �01'nl �r^I J /�Ghc 'f�'ccJt' 1 u <br /> Acres: LA). / :�cl�� <br /> (If parcel is to be surveyed,provide <br /> ^preliminary map. See attached <br /> �for preliminary map requirements.) <br /> Proposed access to public road: /'it Va /)t-t Af& - ` j" Ajet w- L�/.C.i d'w �-/ <br /> /rJ�/ lCl d <br /> Proposed access to public waters to be provided� m <br /> If yes,describe access: <br /> L <br /> Signature of OwnerWVI_ Dater <br /> m <br /> 0 <br /> P° Signature of Owner: Date: c -tC <br /> ➢ Does parcel meet Zoning Requirements? Yes No et - m <br /> 17-8-1-1 <br /> Does parcel require a Survey? C� No ti <br /> Permit application feessubmitted? Amount$ u Receipt# 10ji 9 _ Jj <br /> lyj <br /> 'o <br /> ❑ Reconciles with Real Property Lister Yes No Dale: <br /> } <br /> If not,explain: 0 <br /> Applicatio Approv / Denied Reason for Denial: <br /> Land Use: Date: -� "/� <br />