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Burnett County Subdivision Permit Application Fees(must accompany forth): <br /> Subdivision w/o Survey: $10.00 <br /> and/or Pre-Application Form <br /> ° Subdivisionw/Survey:5100.00+SI5.00/lot <br /> 1)G( <br /> Owner: t A IP -11l ne iar l/v-S <br /> b <br /> Address: / blc.( e <br /> / i5 p�CpD <br /> U e'b- ' l <Nl �yO/�' Phone: <br /> /,3,/Orieinal Parcel Information / ,/,, / J <br /> Parcel Identification#: t%o� b"N �D 3,dV Section Township yJA Range /i/tv <br /> t 0 <br /> Original Description(or attach copy): dW NC� S.w P N/ <br /> So (d 2s IR �a.a lta N�1'i�bo. ¢. Neafti R� 43 �°3� <br /> 9 p <br /> Current Zoning: R9 3 Floodplain Y,l&> Wetlands Y& <br /> Lake/River Classification: Name of Water Body: <br /> New Parcel Information <br /> I ra <br /> Proposed New Legal Description and Parcel Size: C or Y A H4,AW Q. <br /> s >vivw 'VXC<a( 2s/ «< t A-404 4"'p- <br /> Acres: i3 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: EXrs 64-f <br /> v J d <br /> Signature of Applicant: `� Date: ////(o�. <br /> r� <br /> w <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N <br /> a <br /> ➢ Does parcel require a Survey? Yes No <br /> p / n <br /> ➢ Permit application fees submitted? ❑ Amount$0 Receipt # <br /> 9 <br /> C <br /> e ❑ Reconciles with Real Property Lister _ Yes No Date: a <br /> C6 -- <br /> �o <br /> R If not,explain: 1 <br /> CK) <br /> o t <br /> 6 <br /> M � <br /> t <br /> Applicatio Approved / Denied Reason for Denial: <br /> Land Use: Date: z/3`d cee D <br />