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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+$5.00/lot <br /> Owner: rjz 014u\ � _M16A L ODuN6I L- <br /> Address: Zy 6 6 3 <br /> 14 1 j(j �, `! �l �l5 Phone: 3y V- <br /> Orieinal Parcel Information A <br /> �� 2 /6 3 <br /> Parcel Identification#: 6l � 'Jj33s�/5e�o��Township .39R/ Range ►�i/ z <br /> �'u r7� o f Lot / d F C 5/Y� <br /> Original Description (or attach copy): 9j <br /> V, ! � 2 -7 2-7z 5� %y .56 /Y � <br /> nr o <br /> 9 Current Zoning: U N 2°Na ( Floodplain N: Wetlands q <br /> lam. A <br /> 10• Lake/River Classification: Name of Water Body: <br /> m <br /> 0 <br /> New Parcel Information /Q C <br /> Proposed New Legal Description and Parcel Size: /CS m " ! l /084-/3J— <br /> Acres• /7• g CJ <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: L/ <br /> Proposed access to public waters to be provided Y0 d <br /> A <br /> If yes,describe access: <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N <br /> ➢ Does parcel require a Survey? Yes No e <br /> 00 <br /> 3 <br /> ➢ Permit application fees submitted? ` Amount$ J ' Receipt # e <br /> A <br /> x <br /> r Reconciles With Real Property Lister es No Date: <br /> m <br /> 0 <br /> a <br /> If not, explain: pa <br /> o � <br /> Vi t� <br /> Application: Approve Denied Reason for Denial: <br /> //-- J <br /> Land Use: Date: 4� d <br /> 2/18/2003 <br />