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Burnett County Subdivision Permit Application iccompany form): <br /> Pre-Application Form Subdivision w/o Survey: $00000 <br /> and/or Pre-A <br /> PP Subdivision w/Survey:$100.00+$15.00/lot <br /> Owner: ffol7t- _/? <br /> 9 9 z AV�l ba-u� <br /> Address: <' n 3 <br /> /7-- <br /> Phone: P <br /> e�k�3333-6/ScY� Original Parcel Informattion <br /> Parcel Identification#: _619-333,3-67-y00 Section Township tLfiL Range�� pq <br /> #0/$-333- pZgoo <br /> Original Description(or attach copy): IE /V W SE ✓V p <br /> 0,A/d 5 W N <br /> > <br /> Current Zoning: ����� Floodplain N5 Wetlands 16 <br /> S <br /> Lake/River Classification: Name of Water Body: <br /> c <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 3 <br /> Acres: 75• /� <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary ma requirements.) <br /> Proposed access to public road: _ /))t u °u it <br /> i <br /> d <br /> Signature of Owner: Date A <br /> J <br /> > Does parcel meet Zoning Requirements? Yes No O <br /> o � <br /> Q > Does parcel require a Survey? Yes No A <br /> > Permit application fees submitted? ❑ Amount$ I D - b Recei t# ?c;)' 9 <br /> c <br /> A <br /> � <br /> [I Reconciles with Real Property Lister Yes No Date: 0 0 <br /> d op OQ <br /> If not, explain: wUM <br /> W <br /> a13 ww <br /> Hjj 1N W <br /> ' do <br /> W - <br /> Application: p roved Denied Reason for Denial: tl <br /> Land Use: lm✓Y) e Date: - S _D 17 <br />