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Burnett County Subdivision Permit Application accompany form): <br /> Subdivisio w/oSurvcy: $10.00 <br /> and/or Pre-ApplicationForm <br /> / s��a;�;S; n wlSurvey:$100.00+515.00/lot <br /> Owner: _ANt ltF E NE l`-ICU dl�1L � <br /> Q � n <br /> Address: <br /> \i ly0.ccytl \1'\ Phone: P <br /> �9J <br /> Orieinal Parcel Information <br /> oZS-ti�vo-02-3 o m CA <br /> Parcel Identification#: Section _Township RangeCA <br /> Original Description(or attach copy): t� 5 VV Ir 6 L 0 <br /> e <br /> 7 Q �1 <br /> Current Zoning: iC d - 2-3 Floodplah /N: Wetlan <br /> Lake/River Classification: Name of Water Body: <br /> New Parcel Informatition <br /> Proposed New Legal Description and Parcel Size: ( 5m <br /> Acres <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary m ip requirements.) <br /> Proposedaccess to public road: / <br /> C <br /> e <br /> Signatureof Owner:y, 'J Dat : "• <br /> IV 2v epa,. t7//�/h Y®�/•bi.�bLrG. /%A) -' 4� <br /> N Does parcel meet Zoning Requireme s? Yes No Q <br /> i Does parcel require a Survev? No ��//R�// <br /> /TV / 3 <br /> O <br /> i Permit application fees submitted. ❑ Amount 5 �U Rec ipt# � <br /> A <br /> a <br /> ❑Reconciles with Real Property Lister Yes No Date: o <br /> ' Z u <br /> 6 <br /> 00 <br /> 2 If not,explain: x <br /> a <br /> © P <br /> Application. A rove enied Reason for Denial: ° <br /> P <br /> d � <br /> Land Use: Date: - J <br />