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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision w/o Survey: $50.00 <br /> Survey of Existing Parcel: $50.00 <br /> and/or Pre- <br /> IApplication Form Subdivision w/Survey: $200.00+$50.00/lot <br /> j� <br /> Owner: Pral�all lit? Y' !� -N1sevi Rd I <br /> Address: 6 4 Q A Rnynhp v' L ak Rd B <br /> 0 Phone: 7�S-o2S9-3183 <br /> Ul <br /> Original Parcel Information <br /> Parcel ID#: (oO() I Section ) 3 Township t O Range p0 <br /> Original Description(or attach copy): Sep d P P d Ota c k P p <br /> F <br /> m <br /> Current Zoning: ER-1 Floodplain Y/N: At Wetlands Y/N: <br /> n p I <br /> o Lake/River Classification: _Name of Water Body: .p0 4111 psr La k� J <br /> New Parcel Information y <br /> Proposed New Legal Description and Parcel Size: SEe. t Ep_s 9 c.�e'd <br /> J <br /> Acres: • 09 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: l�hV1U <r Cage' ROq� <br /> Proposed access to public waters to be provided Y/N: _ <br /> d <br /> If yes,describe access: <br /> D,- <br /> Signature of Owner C t P Date: /,z/IF/6 A�AII <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> o � <br /> ➢ Does parcel require a Survey? Yes No e <br /> �� <br /> Permit application fees submitted? ❑ Amount$ w• �U Receipt# � 0�s � <br /> t ❑ Reconciles with Real Property Lister Yes No Date: �\ 0-7 <br /> c C)' <br /> �y If not,explain: <br /> o � <br /> C6 <br /> _ J <br /> [✓r CoAd <br /> Application: Approved / Denied Reason for Denial: fS 405 WI 2 <br /> be r a-•�-� � sr � /2ARc - of <br /> u ^^ , <br /> Land Use: Date: <br /> O <br /> C <br />