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Fees(must accompany form): <br /> Burnett County Subdivision Permit Application Subdivision Vo Survey: $50.00 <br /> and/or Pre-Application Form Survey of Existing Parcel: $50.00/!et <br /> PP Subdivision w/Survey: $200.00+$50.00/lot* <br /> I 1� II <br /> Owner: SAr1n4 Lynn\ Andirs'or\, <br /> Address: °1 � 2.() kL� <br /> e\Ver C-AroJe �udlnt< Mtj 550-76 Phot a <br /> Original Parcel Information <br /> Parcel ID#: Sefcn �grce�5 (5ee 04C�e4) Section_;_� Township\Range /7 <br /> Original Description(or attach copy): Sf dte l �Fnr cB�5Sf e. a 4kc�? d I 0 <br /> °m <br /> . 1 <br /> Current Zoning: RQ-'Z Floodplain Y/N: y Wetlands Y/N: <br /> R:Jert + <br /> o Lake/RiverClassifcation: Slre.n, t 1) Name of Water Body: µ-A%,) G(ZEeIe- <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: Ro�I t,/ 100. 0 's ACoCS �p <br /> CoMbiniy�a 7 parciek ir\ 6 I <br /> Acres:�' Q Q • D 5 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: .TV\ yjas��'m ON - <br /> - swls-S ('NUJ 1�-aa <br /> Proposed access to public waters to be provided Y/N: /VO <br /> If yes,describe access: m <br /> J' A <br /> Si u n Date: <br /> o ➢ Does parcel meet Zoning Requirements? No p <br /> o � <br /> T- Dues parcel requlr e a 5ui ve, yes <br /> O <br /> Permit application fees submitted? 11Amount$ Q 5Q,C)o Receipt# W 9 //b <br /> e <br /> w <br /> A <br /> 1 <br /> 1 ❑ Reconciles with Real Property Lister Yes No Date: ?k <br /> e <br /> a <br /> qy If not,explain: <br /> rg <br /> 0 <br /> a <br /> w <br /> Applicatio Approved ! enied Reason for Denial: �y <br /> Land Use: Date: <br />