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r 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+$5.00/lot <br /> Owner: ba� j2uNNirJ( <br /> Address: 53 8rp WG—,T— S'-i— <br /> SP'V 4 G f M+J 5 5378 Phone: 95z- - 890 - 5 a 9,.,4- <br /> Orieinal Parcel Information •a <br /> 0zC)436Zo 3500 3 <br /> Parcel Identification#: 0 z o4-5p z o 4400 Section Z Township +o Range <br /> z <br /> Original Description (or attach copy): A1TRc Nc-i�-'> <br /> Current Zoning: Floodplain Y/N: n/6 Wetlands Y/N: N0 <br /> •o <br /> Lake/River Classification: 3 Name of Water Body LooN Crzb�l� FF(rr� <br /> m , <br /> 2 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: _ C c-t?T F1 cD> Sc)YZV c:� M A r- <br /> E(I i ST-)nl G NrZOATC-P , <br /> Acres: 1 ,3-7 3 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> J <br /> Proposed access to public road: del T-b I/i rj R oAID� , <br /> Proposed access to public waters to be provided Y/N: y(ES C <br /> m <br /> w <br /> If yes,describe access: Le 1 Is a rj Loon/ c'Rzzt�lG <br /> Does parcel meet Zoning Requirement 9 Yes No W <br /> N <br /> ➢ Does parcel require a Survey? Yes No A <br /> o <br /> 00 3 <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> A <br /> r a <br /> ❑ Reconciles With Real Property Lister Yes No Date: <br /> a <br /> If not,explain: 0 0 <br /> Q <br /> Application: Approve Denied Reason for Denial: <br /> Land Use: Date: <br /> 2/18/2003 <br />