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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-A lication Form Subdivision w/o survey: $10.00 <br /> ILII Subdivision wlSurvey:$100.00+$15.0011ot <br /> Owner: DA j E4 I�NY MC CA J^J <br /> Address: 41 D(o CV,wre, f?—Oon_1:> <br /> S"10R� 3 <br /> E B L9k67 OE* 5V83 a Phone: <br /> 0 <br /> Original Parcel Information <br /> Parcel Identification#: ZZ Z — D I YODSection ZZ Township �� Range <br /> J <br /> 0 <br /> c <br /> Original Description (or attach copy): , <br /> ZZ o <br /> M Current Zoning: _PltZ7�> FloodplainY/N: WetlandsY/N: C <br /> New Parcel Information <br /> Proposed New Legal Description and Par/cel Size: C i <br /> Lea � t��2�Pol c5f `� Nei,.) <br /> Acres: Ac fPC <br /> (If parcel is to be surveyed,provide preliminary map. See attachedfor preliminary map requirements.) <br /> Proposed access to public road: b l f-sl A cepes _ j6 _'7,\O re /LD�4p <br /> Proposed access to public waters to be provided YIN: V\ 1D <br /> If yes, describe access: <br /> v <br /> v <br /> A <br /> Signature of Owner: Date: <br /> C <br /> Does parcel meet Zoning Requirements? Yes No QJ <br /> Does parcel require a Survey? Yes No J <br /> Permit application fees submitted? ❑ Amount S �d Receipt# <br /> 0 <br /> B <br /> 9 <br /> ❑ Reconciles with Real Property Lister Yes No Date: <br /> If not,explain: p <br /> m <br /> Applicatio : Approved / enied Reason for Denial: <br /> Land Use: Date: <br /> C7 <br /> O <br />