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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Suwey: $50.00 <br /> ey of Exisnn arce: %Aot <br /> and/or Pre-Application Form vision urvev: Hot <br /> Owner: VIM and inAe-Ah bat) % S Buyer: b <br /> Address: 3 0 3 I�;a h�o±n'�e. ( urdC Address: 9 <br /> a Se%f; Ilei A4 55113 0 <br /> Phone: Z - O 3 - 3J S Phone: W <br /> W <br /> Original Parcel Information <br /> q�7 �--/ a0S- 'o <br /> //aov <br /> Parcel ID#: Q i ' 2O^ 2- �{Q.�(,-D2'05 Section 2 Township Range �� O <br /> L <br /> Original Description(or attach copy): <br /> Y <br /> ° Current Zoning: Floodplain Y/N: Wetlands YIN: A sR <br /> /� ra <br /> Lake/River Classification: o�f Z Name of Water Body: Fq/K L4i(P <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: A <br /> Acres: /Z <br /> (If parcel is to be surveyed,provide preliminary map. <br /> -See attached for preliminary map requirements.) <br /> Proposed access to public road: Y / <br /> S Ci <br /> ` l K1 C <br /> d <br /> Proposed access to public waters to be provided Y/N: S A <br /> If yes,describe access: 15XISTIA16- )901e-Cel AQf rbacl 6tzeJf f- QC!_Psl� O <br /> c Signature of Owner: �/ L' I P / 10— Date: Odo <br /> �XIriIW6- A+ltcI=L <br /> 00 Signature of Owner: Date: n <br /> 0 <br /> i3 <br /> o <br /> ➢ Does parcel meet Zoning Requirements? (:�Yes No <br /> e ➢ Does parcel require a Survey? yes No 0 <br /> (� Q <br /> Permit application fees submitted? ❑ Amount$'5z' o Receipt# <br /> 0 0 � <br /> ❑ Reconciles with Real Property Lister Yes No Date: W <br /> e o <br /> If not,explain: <br /> � d <br /> G W <br /> I <br /> O <br /> Application: Approv / Denied Reason for Denial: !S iry Q-Qfe� 4*-Veg," G <br /> c <br /> �y p a <br /> Land Use: Date: / '9q OO o <br />