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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+$5.00/lot <br /> Owner: ��j{�jS/l J �� GO �C/f Z/)/ t)0 C/e- <br /> Address: L ,30 X 3 41. <br /> 4A,11 ✓��f�� Phone: <br /> Original Parcel Information <br /> O1a-Uaa3- Ut-1 3 <br /> Parcel Identification#: / Section_Township '-f 6 Range As <br /> z <br /> Original Description (or attach copy): C'L J— �X C.L-P—tt esi <br /> z <br /> 0 <br /> Current Zoning: R-r5 Xego r Floodplain Y/N: Wetlands Y/N: <br /> o <br /> °• Lake/River Classification: �,� /1 U r Name of Water Body: <br /> m rb <br /> New Parcel Informatio�ny / <br /> Proposed New Legal Description and Parcel Size: /y©4- 1 h <br /> / fe ...;,o.. +�... u; u � �?; �" .�" i` Acres: '`- ,v 4 w �' <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 1 (� <br /> pJ <br /> Proposed access to public waters to be provided Y/N: ' :''' I �� �� d <br /> A <br /> If yes, describe access: <br /> 1 <br /> ➢ Does parcel meet Zoning Requirements? QY7esNo BURNETT COUNTY <br /> N ZONING c <br /> ➢ Does parcel require a Survey? Yes No ' <br /> ° 3 <br /> ao <br /> ➢ Permit application fees submitted? Amount$ l0. OD Receipt# 53 <br /> e <br /> A <br /> ❑ Reconciles With Real Property ListerCL Yes No Date: Q <br /> a � <br /> r <br /> If not,explain: <br /> o , <br /> N � <br /> G <br /> Applicatio Approv / Denied Reason for Denial: <br /> Land Use: Date: ff`U L/ <br /> 2/18/2003 <br />