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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-A lication Form Subdivision w/o Survey: $10.00 <br /> P� Subdivision w/Survey:$100.00+$15.00/1ot <br /> Owner: R6 berfi Pt /(dMa-.f—a_� p/ <br /> Address: _ I/�/ ��/�y� t�G?Z/Z V /L�-, /- . /� f'-15 - ?614- 7 316 1 <br /> �� ""�PLt V� J24 §5 Phone: o <br /> -4 a 1a-- yaa5- a-i666 Ori¢inal Parcel Information <br /> Parcel Identification#: -#D/Z -4/ZZ5`d.0/oSection �r Township Range <br /> Original Description (or attach copy): 0 <br /> Current Zoning: /C/� t' Floodplafi( ' : WetlandON- <br /> (A55 /I/ x7`71 a�a,t/o� L,c,C t <br /> Lake/River Classification: Name of Water Body: t <br /> ggj <br /> New Parcel Information D <br /> l <br /> Proposed New Legal Description and Parcel Size: ' <br /> reth15Nj Lo[ L;Ne, <br /> d6 Acres: 7 7 Z <br /> D <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) p <br /> Proposed access to public road: d7,/Lj�J1U�Q �tL /C. <br /> FI/t L (4 G O�LG�, <br /> Signature of Applicant: Date: /S=_01y <br /> .9i <br /> r . <br /> ➢ Does parcel meet Zoning Reguiremer,LT-�' No <br /> o O <br /> ➢ Does parcel require a Survey? No <br /> n <br /> ➢ Permit application fees submitted? ❑ Amount S 3 Q 0 U Receipt# I O 5 l_ b <br /> e <br /> A <br /> ❑Reconciles with Real Property Lister Yes No Date: o <br /> a � <br /> oIf not,explain: a <br /> w N N <br /> ✓1J1 <br /> O Vj <br /> Application: Approved 1 enied Reason for Denial: 'See 1 o <br /> o � <br /> Land Use: Date: <br />