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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 wiSmvey:$100.00+sis.00not <br /> l <br /> Owner: 6 u-) /l/po E LW S <br /> Address: 1064.. 61Y 15-1 L /� <br /> �uj, 71//' �7 g�J�1-C�Jd7 Phone: 1- -716— �56— yIX?0 <br /> Orieinal Parcel Information / 3 <br /> Parcel Identification#: Section a4 Township VI V Range o <br /> Original Description (or attach copy): <br /> y Current Zoning: Floodplain Wetlands Y6-P <br /> 9• Lake/River Classification: � Name of Water Body: <br /> m <br /> New Parcel Information t <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> it � <br /> Proposed access to public road: `J. T i�H 7 — S 6 Leh s 5T- <br /> d <br /> Proposed access to public waters to be provided V6A <br /> If yes,describe access: <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N n <br /> °o ➢ Does parcel require a Survey? Yes No B <br /> O r <br /> 00 C <br /> ➢ Permit application fees submitted? ❑ Amount S Receipt# <br /> x <br /> o ❑ Reconciles With Real Property Lister Yes No Date: <br /> a IJ <br /> cIf not,explain: <br /> c <br /> w <br /> CA <br /> t <br /> Application Approved Denied Reason for Denial: O <br /> c� <br /> Land Use: Date: <br /> 2/18/2003 <br />