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Burnett County Subdivision Permit Application Fees(must accompam form): <br /> Subdivision w/o Survey: $10.00 <br /> and/or Pre-Application Form <br /> A Subdivision w/Survcv:Sl(x).110+Sl5.(X)1iol <br /> Owner: �(�GK /(��y� ► �za- Nfi.�, J <br /> Address: 69�y �.Y,Q(,7 (5 / p <br /> �uebs?i- r li I ' �yR�3 <br /> 20-Lt Phone: 0p�j� - /r7 C7 I <br /> o - <br /> 07-vo- 03600 - 03ct0 Ori-ainalParcel Information <br /> 03zvo - p 3300 <br /> Parcel Identification#:& -V327-�3't^�� Section Z7 Township Range <br /> Original Description(or attach copy): 5 61_(Ic J �A �A/ /y <br /> O <br /> F <br /> e <br /> A <br /> s � <br /> A <br /> Current Zoning: A Z rb Floodplain 1/N Wetlands <br /> Lake/River Classification: Name of Water Body: <br /> New Parcel Information g <br /> Proposed New Wilk / 10--s <br /> � <br /> pos Legal Description and Parcel Size: C 5/)") L. <br /> Acres: <br /> (If parcel Is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 1 1 <br /> Signature of Applicant: /1'1Vc./c' t'c. KIZ Eu J Date: O , 9' <br /> A <br /> Does parcel meet Zoning Requirements' Nov <br /> 0 <br /> = ➢ Does parcel require a Survey? Yes No <br /> a <br /> m <br /> ➢ Permit application fees submitted? ❑ AmountReceipt# <br /> $ A <br /> 3 <br /> e <br /> ❑Reconciles with Real Property Lister Yes No Date: NN <br /> a o <br /> 70 <br /> R If not,explain: ° o <br /> 3 We ci ' <br /> JJVjJ <br /> WO opo <br /> www <br /> Application: pprov / Denied Reason for Denial: o�c coo <br /> o'O Opp' <br /> Land Use: Date: 'may rI� <br />