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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/orPre-A Pre-Application Subdivision w/o Survey: $10.00 <br /> PP Subdivision w/Survey:$100.00+$15.(I(0ot <br /> Owner: . CLLR W -rzaryq <br /> 691N 19.w;1 s l <br /> Address: r�d <br /> lel �('/ /b <br /> (,Veb er r SPhone: U ym - a I <br /> ozo-4329 — P <br /> D2-vo- 0 3000 - 6-6016 Original Parcel Information <br /> Parcel Identifica on#: 026 -732�7'65 166 Z'� yX l� <br /> Section Township U Range <br /> Original Description(or attach copy): 541( SIN t Al lI p <br /> E <br /> e <br /> A <br /> a <br /> Current Zoning: D Floodplain 16J, Wetlands Y� <br /> Lake/River Classification: Name of Water Body: <br /> New Parcel Information <br /> C5m 2 7101 <br /> Proposed New Legal Description and Parcel Size: (�1 s <br /> E <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) f f <br /> Proposed access to public road: Co Ut�n kocaA C ' bki,i k <br /> RZ- <br /> p v <br /> Signature of Applicant: n 1CeJc fZ - K2atsr p Date: <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> 0 <br /> �• ➢ Does parcel require a Survey? C:—� No <br /> � A <br /> 0 <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# 9 <br /> e <br /> m <br /> ❑Reconciles with Real Property Lister Yes No Date: o a o a <br /> If not,explain: c r u <br /> d0000a <br /> WWwW W� <br /> wDe o 0 <br /> ApplicationApprove / Denied Reason for Denial: e Do $ c <br /> 0 <br /> Land Use: Date: <br />