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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: $10.00 <br /> and/or Pre-Application Form <br /> n `�j� �,^ _ / Subdivision w/Survey:$100.00+S 15.00Aot <br /> Owner: ey-tg Ll�r�� JCG1 ri I A / V(ll h.•/C.uzl / <br /> Address: _�J7 ha � N C� �d aa7G; <br /> �l ,IN Phone: --(,e 3� 939y <br /> �y1111V- <br /> 6 Ori incl Parcel Information <br /> G 350 _ / g <br /> Parcel Identification#: 029 '`/113'0015 Section. /V�3 Township /VRange %�/l'V e <br /> Original Description (or attach copy): <br /> N� /y ,UE% 5>`C a 3 u) <br /> Current Zoning: 1414Floodplaln YQ Wetlands Y <br /> F Lake/River Classification: `_ Name of Water Body: <br /> 4� <br /> New Parcel Information 4- <br /> Proposed New Legal Description and Parcel Size: Cm V <br /> Acres: 12-, /'7 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) t-�- <br /> n <br /> Proposed access to public road: i/��� 1 <br /> Proposed access to public waters to be provided <br /> Y(9 d <br /> n <br /> If yes,describe access: <br /> 1 <br /> 09 <br /> D Does parcel meet Zoning Requirements? Yes No C <br /> ➢ Does parcel require a Survey? A <br /> No B <br /> D Permit application fees submitted? ❑ Amount$ <br /> Receipt# A <br /> Yr <br /> 0 Reconciles With Real Property Lister Yes m d <br /> CL No Date: <br /> If not,explain: <br /> a � — <br /> G � r <br /> 1 <br /> A licatio A w <br /> PP pprov / Denied Reason for Denial: ' <br /> � O <br /> aO <br /> Land Use: a�� Date: 7`/e/l d 5 <br /> i/lsao03 <br />