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Burnett County Subdivision Permit Application Fees(mustaccom any form): <br /> and/or Pre-Application Form Subdivisionw/oS rvey: $Io.00 <br /> /�,., Subdivisionw/Su ey:$100.00+$15.00/lot <br /> Owner: k9t(.(LCL &Q P//m <br /> Address: �/3D I y <br /> lJ YVi Phone: —a'?M7 0 <br /> Orieinal Parcel Information <br /> Parcel Identification #: Q�jy-�J�9-03� Section3'� <br /> 19 Township Range /0 J <br /> Original Description (or attach copy): Yq p f E I <br /> clO <br /> a <br /> C . <br /> 7 a <br /> Current Zoning: // —/ 4-4 Floodplain Yo <br /> Wetlands <br /> Lake/River Classification: <br /> Name of Water Body: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: e <br /> Acres: <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Signature of Owner: / o / t7 <br /> / Date: /' O <br /> c ➢ Does parcel meet Zoning RequiremenNo <br /> t . Yes` w <br /> ➢ Does parcel require a Survey? Yes o <br /> 00 No J <br /> ➢ Permit application fees submitted? ❑ Amount$ l I S D 6q <br /> Receipt#k a o <br /> mReconciles with Real Property Lister Yes <br /> a <br /> No Date: a <br /> A <br /> R If not,explain: (p <br /> o � <br /> a <br /> N <br /> \n <br /> W <br /> Application: Approve Denied Reason for Denial: � QQ Lf <br /> /AJC 4Jl �L(JtiC W <br /> rA <br /> Date: 5149--47 <br />