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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> and/or Pre-Application Form Survey of Existing Parcel: $50.00/lot <br /> nn��,, PP Subdivision w/Survey: $200.00+$50.00/lot <br /> Owner: 1. ACA. h ,o <br /> /')Lm <br /> Address: 3 <br /> S5 5 <br /> Phone: <br /> '13,;23_09266 <br /> / <br /> Original Parcel Information /� / A/ <br /> Parcel lD#: !/�Q ` /3,;23_0 0266 //Section d.3 Township 714 Range <br /> Original Description(or attach copy): Pe L (Sio V 7�_T �p <br /> DeSS PC, 20Lo 1 3( 0- 675 <br /> a <br /> Current Z ping: IL"p— Floodplai Yi: WetlandI: �p <br /> Lake/River ification: Name of Water Body: �J6/�/YLtTL �fCJ� <br /> New Parcel Informatiioonn <br /> Proposed New Legal Description and Parcel Size: /�✓WYt �t �Lt �i(.QJC/ <br /> New C SAJ <br /> Acres: $C <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: IUJ QYV //`lL.f�C R-/ Il�JQ7CiD�� <br /> Proposed access to public waters tp be provide GAtr of <br /> If yes,describe access: % m <br /> Signature of Owner: Z14L_ //l!I Date: _4 <br /> e ➢ Does parcel meet Zoning Requirements? U/ Yes No <br /> 0 <br /> ➢ Does parcel require a Survey? Yes No <br /> n <br /> 0 <br /> D Permit application fees submitted? ❑ Amount S Receipt# <br /> e: <br /> A <br /> m ❑ Reconciles with Real Property Lister Yes Date: ?t <br /> If not,explain: F 9J <br /> o <br /> a -C <br /> H �Wl <br /> Apphcst' n: Approvedeason for Denial O j <br /> _. 00 <br /> Land Use: Date: <br /> a <br />