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Fees(must accompany forn <br /> Burnett County Subdivision Permit Application Subdivision w/o Sarver $JUQO <br /> Survey of Existing Parcel: $50.001,01- <br /> and/or Pre-Application Form Subdivisionw/Survey: $200.00+$50.00/lot <br /> Owner: N /FYN� �/y/su�/Z d <br /> Address: O/ OS32 1 I� rin 4/n�/� i�bxD p 9. <br /> L VLK/ Yr I S� c3�3 Phone: 7/-S--3Z7 -- 93_�z F <br /> 31 <br /> Orieinal Parcel Information <br /> ParcelID#: t77^o3'f-z '37-/8 zG-3 Section Z.e. Township '37 Range <br /> 0 2-oco-O//000' 0 <br /> Original Description(or attach copy): <br /> O <br /> Y of <br /> b Current Zoning: /F -Z Floodplain Y/N: o Wetlands Y/N: /1�G <br /> Lake/River Classification: Name of Water Body: <br /> New Parcel Information t <br /> Proposed New Legal Description and Parcel Size: 5oVTH 330 t r/a /y/4✓�/ <br /> Acres: lD <br /> (If parcel is to be surveyed.,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: X6 V'V'> 4/� od <br /> Proposed access to public waters to be provided Y/N: _1410 <br /> If yes, describe access: o <br /> A <br /> O <br /> Signature of Owner.. Date: "0`��''�0 S� <br /> (ev ➢ Does parcel meet Zoning Requirements? Y No Q <br /> 0 <br /> 3 Does parcel require a Survey? "res No n <br /> 0 <br /> Permit application fees submitted? Amount$ Receipt# —�7 0 <br /> V ❑ Reconciles with Real Property Lister Yes No Date:— \U\,\21 <br /> o. \�__.._.... — p <br /> If not,explain: <br /> m - — -C <br /> $ 1 <br /> a D)N <br /> Application: Prov / Denied Reason for Denial: <br /> 1 <br /> Land Use: Date: <br />