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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form subdivision w/o Survey: $10.00 <br /> Subdivision w/Survey:S 100.00+S 15.00Aot <br /> Owner: t / 7 L) Y (� L u_ree <br /> Address: 5 G, p <br /> Phone: (7i.t� <br /> Orinal Parcel Informationoi8 - ¢_03 - 3 v <br /> 3 <br /> Parcel Identification#: v i K3 3 ad e- Li sectiony <br /> Township 3 I Range t (a o <br /> Original Description (or attach copy): S 12 VI-e- AJ 0 % <br /> O <br /> Current Zoning:g Floodpla Y Wetlan s <br /> 9• Lake/River Classification: Name of Water Body: L <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: S (v <br /> Acres: —ly Cj <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 5_ <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> ➢ Does parcel require a Survey? Yes <br /> � No 9' <br /> Permit application fees submitted? ❑ Amount Se <br /> Receipt# ,C^. <br /> r ?� <br /> ❑ Reconciles WithReal Property Lister Yes �- 0 05 D o <br /> a —Nom Date <br /> eIf not,explain: <br /> a i F1. o O <br /> u V <br /> Application: Approved / enied Reason for Denial: W <br /> Cc <br /> Land Use: Date: <br /> 2/18/2003 <br />