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Burnett County Subdivision Permit Application [Subdivisionw/)Survey: <br /> ust acc mpany form): <br /> $10.00 <br /> and/or Pre-Application Form isionw/Survey:$100.00+$15.00/lot <br /> Owner: l 1 U 5S e- ( � C. Ne- Isco eist <br /> Address: Na5cil, TICfZ ap1cf NayC Ozt,7 I) <br /> f�! South e 3?oz <br /> yy( t y�el�T M/� S S Kb Z Phone: 76 ' q 7 <br /> C/a <br /> Original Parcel Information <br /> oi ? 4ZZ —0 0 <br /> Parcel Identification#: OIL- 4115--40 O& ! Section 25 /Township L16 _Range <br /> Original Description (or attach copy): J ec, eo O <br /> R <br /> a ' <br /> m Current Zoning: Il?- Floodplain Y/N: N Wetlands Y : N <br /> .. Lake/River Classification: Name of Water Body: /Y p�(1 rA S nJ Lake <br /> New Parcel Information U <br /> Proposed New Legal Description and Parcel Size: <br /> 1See alfact.J <br /> L,fs GcWd z C S fIf ft/0. Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map i equirements.) <br /> Proposed access to public road: ci d co f ki I rt <br /> 0 <br /> Signature of Owner: 10 Q 1C&Ir Date: t Z <br /> ➢ Does parcel meet Zoning Requiremen ? 5mount <br /> No <br /> N ➢ Does parcel require a Survey? No➢ Permit applicationfees submitted? Receipt#1 9 <br /> e <br /> A <br /> r # <br /> m [IReconciles with Real Property Lister Yes No Date: <br /> e <br /> a v w <br /> If not,explain: l <br /> c W v <br /> N <br /> 1 <br /> � c <br /> Application: Approved Denied Reason for Denial: J <br /> 1 - <br /> �! V1 <br /> Land Use: Date: <br /> /J 1'i-t- (0 2 o 0 <br />