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Burnett County Subdivision Permit Application Fees(must ccompanyform): <br /> Subdivisio w/o Survey: $10.00 <br /> and/or Pre-Application <br /> Form s�bawisio w/s�rvey:$too.00+$ts.00no� <br /> Owner: -Zrr // <br /> Z (., I Ai' &)t <br /> .1 <br /> Owner: <br /> Address: 598 Q�� �/(�Q 3 <br /> Dom% Phone: /� 0fxo' / /0� o <br /> W <br /> Oriainal Parcel Information A) <br /> _ -C <br /> Parcel Identification#: t &_Y32*-e Z7ao Section c211 Township Range 114 <br /> Original Description(or attach copy): .5c I � 5 W YLI <br /> 5A) _:�c t p <br /> F <br /> e <br /> m' Current Zoning: Floodplain YQ Wetlands —(Vc <br /> Lake/River Classification: Name of Water Body: <br /> Si <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> c <br /> Acres: 5.60 T <br /> (If parcel is to be surveyed,provide preliminar in See attached for preliminary ma 3 requirements.) <br /> Proposed access to public road: ptLPIL6v <br /> Signature of Owner: V! , Date �/1� X <br /> (N <br /> a <br /> o ➢ Does parcel meet Zoning Requirements? Yes No J <br /> ➢ Does parcel require a Survey? Yes No <br /> oa A <br /> 0 <br /> ➢ Permit application fees submitted? ❑ Amount$ /l5 0 D Recei t# /b O3 1 a <br /> e <br /> A <br /> 11 Reconciles <br /> Reconciles with Real Property Lister Yes No Date: o 0 <br /> If not, explain: <br /> a � � <br /> 0 <br /> Cv � <br /> Application: Approved / Denied Reason for Denial: 6 <br /> 4 <br /> Land Use: Date: <br />