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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+$5.00/lot <br /> Owner: <br /> Address: /S*t avihLArj <br /> XeHie V G1 MN 5 _VPhone: G ✓ Z , �'— 7 / ) <br /> Orieinal Parcel Information <br /> Parcel Identif►cation #: 224 —03—� B <br /> �� Section��ownship Range / <br /> -Z20 <br /> Original Description (or attach copy): <br /> 4P. Zs� <br /> 01 <br /> Current Zoning: rFloodplain Y� WfetlandsY N� <br /> �• Lake/River Classification: l Name of Water Body: <br /> d <br /> 0 <br /> New Parcel Information /0`*S <br /> Proposed New Legal Dscription and Parcel Size: II <br /> �e <br /> ,p�. � tst� Lo OtS <br /> L%j 460rj Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: CX' 't "� �'y� �Jd�requirements <br /> Proposed access to public waters to be provided Y/N: m <br /> A <br /> If yes,describe access: <br /> ➢ Does parcel meet Zoning Requirements? Yes No S� U�r/lt.✓c C' <br /> N pp <br /> °o ➢ Does parcel require a Survey? Yes No Ql o <br /> e <br /> ➢ Permit application fees submitted? Amount$ j5'° Receipt <br /> A <br /> r � <br /> Reconciles With Real Property Lister Yes No Date: O <br /> A° If not,explain: <br /> 0 <br /> a <br /> H <br /> NVtI <br /> _ v <br /> Applicatio . Approve / Denied Reason for Denial: <br /> �i <br /> %JLand Use: Date: 7 —��'U 3 <br /> 2/18/2003 <br />