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Burnett County Subdivision Permit Application Fees(must wcompany form): <br /> Subdivision w/o Survey: $10.00 <br /> and/or Pre-Application Form Subdivision w/Survey:$100.00+$15.00/lot <br /> Owner: <br /> Address: cf (p I q C q <br /> awl Phone: 2/S 3 4 / 5 3 ` <br /> A <br /> Orieinal Parcel Information 3 <br /> Parcel Identification#: /A-3 -3�6.27SSection _Township Range / 7 W z <br /> j� o <br /> Original Description (or attach copy): �S / 'S W1 �- <br /> Y <br /> O <br /> ^/ - � � / f <br /> 9 Current Zoning: � 1^ Floodplain Y/& Wetlands Y/pY <br /> m• Lake/River Classification: Name of Water Body: <br /> e <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> S�.T►otl 33 �1'w►13F'1 l`� C7 I�/ � ��`'' <br /> 1 <br /> Acres: ( Z <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> C7 <br /> Proposed access to public waters to be provided Y/N: � <br /> If yes,describe access: <br /> 93 <br /> W <br /> , <br /> ➢ Does parcel meet Zoning Requirements? Yes No P <br /> S <br /> ➢ Does parcel require a Survey? Yes No <br /> ao <br /> 0 <br /> ➢ Permit application fees submitted? ❑ Amount S IC)' b O Receipt# 7 e <br /> u <br /> at- ❑ Reconciles With Real Property Lister Yes No Date: <br /> m � <br /> ;a If not,explain: <br /> 0 <br /> a -4r- <br /> H W <br /> w <br /> Appli n• Approved Denied Reason for Denial: <br /> Land Use: 1, � <br /> Date: %,- � "-61� L' <br /> 2/18/2003 <br />