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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+$5.00/lot <br /> Owner: ��C G NF 'j£^15 E'J <br /> Address: _55- (b7 �(" G O rzc�A c) <br /> (�1 �l 7E" ((jC IZ LA& F' Phone: �1'2.- 01 ZZ <br /> M N .S5 I/O <br /> Original Parcel Information A <br /> Parcel Identification#: O Ya /0 V 176 O Section /Q Township Range ^� <br /> z <br /> Original Description (or attach copy): <br /> oc� <br /> oa <br /> O <br /> Current Zoning: � h Floodplain Y/N: Wetlands Y/N: � <br /> .a z <br /> o <br /> Lake/River Classification: AT Name of Water Body: N <br /> m <br /> e <br /> '. New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 3�,—.3 <br /> G Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: <br /> If <br /> Ie O <br /> If yes,describe access: <br /> ➢ Does parcel meet Zoning Requirements? No BORNE <br /> --, TT Cp <br /> ➢ Does parcel require a Survey? Yes No ZONING UNTy c <br /> o � <br /> DO 9 <br /> ➢ Permit application fees submitted? Amount$ S�-OD Receipt # <br /> T <br /> A <br /> 1K <br /> M <br /> Reconciles With Real Property Lister Yes No Date: <br /> a <br /> If not,explain: Q <br /> 0 <br /> H 14� <br /> 1 <br /> Applicati Approve Denied Reason for Denial: C <br /> I <br /> Land Use: Date: <br /> 2/18/2003 <br />