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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+$5.00/tot <br /> (1 <br /> Owner: a-ri.-Li Kt Mde b <br /> Address: (y N. Ly2�1d y'S ' ,/ <br /> 1 Ort S� Lc_ K-e, 1 ►llJ 556[•6 Phone: <br /> Original Parcel Information m <br /> 36-yyr3-Uro-sem, n1�/ 3 <br /> Parcel Identification#:�E,-yy/3-06-1760 Section_�Township Vc '/ <br /> Range z <br /> Original Description (or attach copy): 6. L• 5 <br /> O <br /> g: �� Flood lain YQ Wetlands Y6)_ OM <br /> Current Zonin p <br /> r <br /> V• Lake/River Classificat on: "" ame of Water Body: �� <br /> 0 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 6 �f n �/ 19 P a a S� <br /> rh <br /> Acres: 5/. Y42_., `^ <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> �. <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: C <br /> d <br /> w <br /> A <br /> If yes, describe access: <br /> 0 <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N <br /> Q ➢ Does parcel require a Survey? fY—es- <br /> .% No sl � <br /> 0 <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# 2 <br /> z <br /> Reconciles With Real Property ListerYes No Date: <br /> If not, explain: <br /> a <br /> N <br /> Applicatio fApproy / Denied Reason for Denial: IPA- <br /> Land Use: Date: —/ 3 <br /> V �1 <br /> 2/18/2003 C <br />