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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form Subdivision w/o Survey: $00000 <br /> PP Subdivision w/Survey:$ 00.00+$15.00/lot <br /> Owner: � u Cd alt yn�i�/ <br /> Address: <br /> J Z0/ ��7g93 Phone: <br /> C� <br /> Oriainal Parcel Information <br /> e&50 Section Parcel Identification#: � Rangep / / <br /> Original Description (or attach copy): <br /> f <br /> e <br /> A <br /> a <br /> Current Zoning: tl J Floodplain Y H: Wetlands Y <br /> Lake/River Classification: Name of Water Body: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: t^�m � <br /> Acres: X3.5 <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Signature of Applicant: 3�-� � �f/L��j/l�� Date: <br /> 00 <br /> 9.� <br /> ➢ Does parcel meet Zoning Requirements? Yes No d <br /> 0 <br /> �• ➢ Does parcel require a Survey? Yes No <br /> oa f1 <br /> ➢ Permit application fees submitted? ❑ Amount S l b l 9 l� Receipt# 0 D 3 <br /> 9 <br /> C <br /> w <br /> A <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> a <br /> If not,explain: <br /> 03 <br /> a (� <br /> W <br /> Application: Approved / Denied Reason for Denial:_ <br /> c.A <br /> Land Use: Date: �J <br />