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Burnett County Subdivision Permit Application Fees(mustaccomp nyform): <br /> and/or Pre-A lication Form sabdivisioaw/oso ey: 00.00 <br /> PP Subdivisionw/Su ey:S100.00+$15.00/lot <br /> Owner: PluL 7kAycc%e. <br /> Address: oy,2— wzZ aCly. -5 n <br /> MAI Phone: o <br /> Original Parcel InformationOLt)- 13 -0;910 9'g312 _ z yp <br /> Parcel Identification 6296U Da <br /> Section 12-13 Township I'Id/v? Range 16W � <br /> Original Description (or attach copy): C7•L y /Z 6. z �3 O <br /> J,JL 051n V <br /> Current Zoning: /CMZ Floodplain l: Wetlands(PN: _ <br /> Lake/River Classification: ���`, S 3 Name of Water Body: 626O/Ye,6 <br /> 0 <br /> New Parcel Information �r <br /> Proposed New Legal Description and Parcel Size: <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 /> 0 <br /> Signature of Applicant: Date: <br /> u) <br /> Does parcel meet Zoning Requirement Yes No d <br /> ➢ Does parcel require a Survey? Yes No <br /> e <br /> Permit application fees submitted? ❑ Amount$5D, Do Receipt# 3 s <br /> e <br /> A <br /> � ❑ Reconciles with Real Property Lister Yes No Date: c o 00 <br /> a <br /> C o bn <br /> � If not,explain: <br /> e <br /> 'es _w Www <br /> `° v wN41 <br /> 0 Oco <br /> 3u 1i <br /> Applicatio Approved / enied Reason for Denial: o I I '\� <br /> oc �o <br /> Land Use: Date: �l <br />