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Burnett County Subdivision Permit Application ESb'd1Vvi1s'iiso <br /> mtaccomp ny form): <br /> and/or Pre-Application Form sonw/oSu Vey: $10.00 <br /> Pp n w/Suri ey:S 100.00+$15.00/lot <br /> Owner: �bL �V�/GF./ <br /> Address: 5&2— ` v- - (L fes. -5 " <br /> n / l J, 7 MAI 5JI 1.2 <br /> rU/t/L eQ�O/i Phone: o <br /> 620- �?-v 8lb dOriginal Parcel Information <br /> z <br /> Parcel Identification#: �Q'q3/2-QZy//9+06 Section 12-13 11'1Township '/e/v/'/e/v/ 16 bt/ <br /> ����" <br /> Range >� <br /> Original Description (or attach copy): C7•L. 7 O /Z G. Z' / /.3 0 <br /> INc C5m V <br /> R Current Zoning: 162- Floodplain <br /> e l: Wetlandst P1: <br /> Lake/River Classification: &4:55 3 Name of Water Body: 6 )O e- <br /> 1 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: L/� <br /> Acres: . 3 t <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> �J d <br /> Signature of Applicant: ' Date S/ G l06' A <br /> C0 <br /> �l <br /> ➢ Does parcel meet Zoning Requirement Yes No <br /> o �) <br /> Does parcel require a Survey? Yes No <br /> n <br /> 0 <br /> Permit application fees submitted? ❑ Amount$5D D/) Receipt# 3 9 <br /> e <br /> n <br /> it <br /> � ❑ Reconciles with Real Property Lister Yes No Date: <br /> 06 c o 00 <br /> roO o bn <br /> R If not,explain: <br /> 0 <br /> 3 _w www <br /> w W yJN41 <br /> i 1 <br /> 0 Oco <br /> + ¢NYl <br /> Applicatio Approved / enied Reason for Denial: o q y <br /> e cL,c <br /> Land Use: Date: <br />