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Burnett County Subdivision Permit Application rue,(must accomPunc rom): <br /> Subttisision"/-Sarvev: 5100) <br /> j1.� <br /> and/or Pre-Application <br /> gF,o�r�m sena,-ision�risarue>-:Siou.00+$is.ianut <br /> Owner: t tlyly m f ///d/d1�it <br /> Address: 2 G i l PU <br /> Phone 'P� <br /> if 6Z0-%3/g-0.3360 Orieinal Parcel Information (� <br /> -qii 00 <br /> 'Par�lld'PfiUtificatlon# #O74' y'I/9-035�OSne� �� do <br /> Township 7Range <br /> Original Description(or attach copy): S�i'4 Y W lV �l tly 5 (A1 &I p <br /> ' 6W/q 5w1 q — a i '7 �e <br /> Current Zoning: I`2 2.J Floodplain6)N: Welland,&N: <br /> a <br /> Lake/River Classification: C" L Name of Water Body: <br /> Y <br /> New Parcel Information - o <br /> Proposed New Legal Description and Parcel Size. <br /> 3 <br /> 1J�Ch'/�Qhc¢.IZo �3 <br /> Acres: <br /> 61 .13 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: u6 temaw, "�a'^ " ta/s If t rL ' l" ".`.s <br /> Signature of Applicant: /t v�/�/L/tom tti k ✓ Date: 7/6 & '• <br /> J <br /> A� <br /> ➢ Does parcel meet Zoning Requirements: Yes No <br /> o � <br /> �• ➢ Does parcel require a Survey? Yes No <br /> n <br /> 0 <br /> ➢ Permit application fees submitted? ❑ Amount$SV (D Receipt q s <br /> e <br /> A <br /> 3 <br /> a C' Reconciles with Real Property Lister Yes No Date: Q, P o <br /> 6 <br /> Rt <br /> O <br /> oIf not,explain: w <br /> a w — tN <br /> Qo a <br /> � t <br /> 1� ww W <br /> Applicatio : Approved /wenied Reason for Denial: t W <br /> Oa o <br /> / Sao <br /> Land Use: Date: <br />