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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: 510.00 <br /> and/or Pre-Application Form Subdivision w/Survey: $25.00+$5.00not <br /> Owner: \o�b1 CerU(r, t- � D.C:�ha, ti <br /> �u�Address: � <br /> i <br /> j,jd gloq <br /> Phone: 35 ' 3(© 2-6 <br /> �p ''ii O�rieinal Parcel Information f / <br /> Parcel Identification#: � A-4/1 (y—Qa Aec lion/_Township YeAfl Range ► V <br /> Z <br /> Original Description (or attach copy): 5E �� S t� / <br /> J <br /> 0 <br /> 9 Current Zoning: l� R 3 Floodplai Y> Wetland Y� )"fez n <br /> m <br /> Lake/River Classification: — Name of Water Body: SIuA/y7/ , <br /> e <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: C!moi V 1`�(n <br /> pI4S_1 V q <br /> I <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: EXrs f r pie A i��ah <br /> Proposed access to public waters to be provided Y <br /> If yes,describe access: 6t <br /> ➢ Does parcel meet Zoning Requiremen ? Yes No d <br /> ➢ Does parcel require a Survey? Yes No t1 <br /> o <br /> ➢ Permit application fees submitted? O Amount$3 `r Receipt# �F <br /> w <br /> A <br /> 1 <br /> r <br /> Reconciles With Real Property Lister Yes No Date: <br /> If not, explain: <br /> a <br /> N <br /> v <br /> Application pproved / enied Reason for Denial: <br /> a <br /> Land Use: Date: CCS 3 ZU <br /> 2/18/2003 <br />