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ON OMPUTER/SCANNED <br /> Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form sabaivisio w/o sarvey: $lo.00 <br /> yy /}PP s°bai"isi° w/Survey:$100.00+$15.00/lot <br /> Owner: JirraZ ( IN GLlI /dv/✓ <br /> X98Address: MM, 3 <br /> .Phone:- o <br /> W <br /> Ori¢inal Parcel Information A) <br /> �} /� L <br /> Parcel Identification#: SectionC211 Township d Range <br /> Original Description (or attach copy): .E YY S W / LI 1�c t p <br /> f <br /> A <br /> 7 1 <br /> Current Zoning: ' ' �" Floodplain YQ Wetlands <br /> Lake/River Classification: Name of Water Body: <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> a <br /> Acres: 56t� T <br /> (If parcel is to be surveyed,provide prelimina map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Signature of Owner: C Date <br /> CN <br /> a <br /> ➢ Does parcel meet Zoning Requirements? Yes No p <br /> o J <br /> ➢ Does parcel require a Survey? Yes No <br /> n <br /> 0 <br /> ➢ Permit application fees submitted? ❑ Amount$ //5- 0 Recei t# D� 9 <br /> c <br /> r9 <br /> r ?� <br /> ❑Reconciles with Real Property Lister Yes No Date: o <br /> If not,explain: o <br /> a � W <br /> 0 <br /> Application: Approved / Denied Reason for Denial: <br /> 08 <br /> Land Use: Date: <br />