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viv k+UMPU i ER/SCANNED <br /> Fees(must accompan <br /> Burnett County Subdivision Permit Application Subdivision w/o Sury .00 <br /> and/or Pre-Application Form <br /> Survey ofnw/i u P==7':$5$50.000+$50 <br /> PP Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner. m h nj Pe'pc, .r TAW"4 .y <br /> Address: ,d .in�✓ 7 / 0,Ve,,0q 1 <br /> i YmSr J SS?G'c( Phone: 7/ -S!c S 7 <br /> Original Parcel Information <br /> ColoUa' 7c9s 0¢ <br /> Parcel ID#: a of - t fe t —oz i D o Section Township ;7 Range / <br /> Original Description(or attach copy): <br /> O <br /> e <br /> Current Zoning: I`C' d Floodplai Y Wetlan Y <br /> .°a Lake/River Classification: t h Name of Water Body: <br /> PA- 5 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: Ser x5ttv eke i <br /> 0 <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> r <br /> Proposed access to public road: <br /> Proposed access to public waters to be provide: PaELeA ej A- nke�ro^f Pn�o <br /> If yes,describe access: m <br /> Signature of Owner: �C�i� U Dat 6 C� <br /> G <br /> oN ➢ Does parcel mee Zoning Requirements? Yes No op <br /> 0 <br /> ➢ Does parcel require a Survey? Yes No <br /> A <br /> 0 <br /> Permit application fees submitted? ❑ Amount$ `S' C)b Receipt# a <br /> m <br /> m ❑ Reconciles with Real Property Liste No Date: ?P <br /> e - <br /> a <br /> qy If not,explain: O O <br /> A W W <br /> o •C <br /> a <br /> N A � <br /> Applicatio Approve Denied Reason for Denial: O o <br /> Of Z <br /> t, J <br /> Land Use: Date: <br /> d <br />