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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:$100.00+$15.0011ot <br /> Owner: C •A.1 I e S W / e Q �ty,, 'I . K 1 r\ <br /> Address: -7 V l G k ( S A J r\ Z ,2— \J �J 2 / <br /> G (-f+_�.Jy1 fit �l �0 3 -7 Phone: I - .2 -7 6 - 5_7S_& <br /> A <br /> Orieinal Parcel Information / 'g <br /> Parcel Identification#: 0.28-`1/�Z Z-a S00 Section 2 2 /Township gOAJ Range \ W o <br /> Original Description (or attach copy): N M LO E X c'er f CA-LA R-0 G-A+ <br /> U� <br /> , / O <br /> Current Zoning: U- 3 Floodplain Y/N: /V A <br /> Wetlands Y/N: <br /> � ca <br /> g <br /> Lake/River Classification: U Vt Lr��✓\ Name of Water Body: 0 h C. <br /> New Parcel Information f <br /> Proposed New Legal Description and Parcel Size: 2 ' � �CJ , A <br /> 3 <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Q v\ L U 4 A <br /> Proposed access to public waters to be provided Y/N: <br /> If yes,describe access: <br /> ➢ Does parcel meet Zoning Requirements.Q Yes No <br /> N A <br /> a ➢ Does parcel require a Survey? Yes No a <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt <br /> u <br /> ❑ Reconciles With Real Property ListerYes No ate: <br /> RJ <br /> a � <br /> If not,explain: <br /> a v <br /> 0 <br /> Applica ' n: Approved / enied Reason for Denial: <br /> G <br /> O <br /> Land Use: Date: <br /> 2/182003 <br />