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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: $10.00 <br /> and,,/or Pre-Application Form Subdivision w/Survey: $25.00+$5.00/lot W <br /> Owner: d l 1 Gt/m F. <br /> Address: 2--5S Z�I I {}Za ra�h La4r� <br /> I <br /> di UZ-IC-C G- dju / V i q8'l Phone: 71,5 —y /OS- yO I <br /> OriOnal Parcel Information <br /> Parcel Identification #: Sectiond,/ / <br /> Township 39 V Range /y�"V -. <br /> z <br /> Original Description (or attach copy): ° <br /> Current Zoning: Floodplain Y& Wetlands Y� O <br /> Lake/River Classification: Name of Water Body: <br /> 0 <br /> New Parcel Informaattion <br /> Proposed New Legal Description and Parcel Size: G � <br /> Acres: to• 3 -' <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 07-b raj1- `l/i� <br /> Proposed access to public waters to be provided Y�9 v <br /> m <br /> If yes, describe access: <br /> t <br /> ➢ Does parcel meet Zoning Requirements? }'es No <br /> N <br /> ➢ Does parcel require a Serve)'? es No n <br /> ➢ Permit application fees submitted? Amount$� Receipt # 10 <br /> / pa <br /> A <br /> r <br /> ❑ Reconciles With Real Property Lister Yes No Date: p <br /> a Q <br /> If not, explain: <br /> o U <br /> z <br /> a <br /> H � <br /> oQ <br /> Application: Approved / Denied Reason for Denial: <br /> J <br /> Land Use: Date: <br /> 2/18/2003 <br />