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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form Subdivision w/o Survey: $10.00 <br /> AA Subdivision w/Survey:$100.00+$15.00/lot <br /> Owner: Jac,K W I jzanj U <br /> 69 lel O'al; 1 s L�Jkt W <br /> Address: `'ppJ� �j 6(0- <br /> 1 I b I Phone: O <br /> I/�� <br /> oz0-432 — <br /> L)2900- 0 3000 - 030 10 Orizinal Parcel Information )} <br /> Parcel Ide Identification -'13Z�-63 UU Z1 nn 16 y✓ j�'rif1 <br /> Section Township U Range <br /> Original Description(or attach copy): <br /> F <br /> 0 <br /> Current Zoning: Z fib Floodplain NOWetlands Y� <br /> o � <br /> Lake/River Classification: Name of Water Body: ---- <br /> New Parcel Information 9 <br /> 2 1rr <br /> Proposed New Legal Description and Parcel Size: C's m (JJ 1—t�, e 0-ts s <br /> Acres: <br /> vs <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: CU U OL�4 kO Qj - /��u, 15 t C! Y <br /> d <br /> q m <br /> Signature of Applicant: KR Q tt A Date: O ' 9" n <br /> < <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> 0 <br /> ➢ Does parcel require a Survey? ci-Xes- No A <br /> 0 <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# a <br /> e <br /> A <br /> ❑Reconciles with Real Property Lister Yes No Date: o a o 0 <br /> If not,explain: <br /> a '4 ��� �� <br /> doogo °� <br /> wWww W,� <br /> W �o 00 <br /> Application Approve / Denied Reason for Denial: o o o <br /> b <br /> Land Use: Date: �' �� <br />