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Burnett County Subdivision Permit Application Fees(must ucompanyform): <br /> and/or Pre-Application Form Subdivision w/o Survey: $10.00 <br /> �i PP Subdivision w/Survey:s100.00+s15.00llot <br /> Owner: _MexT iib mt _ ow tt d1r, <br /> Address: 7150 UL Roo <br /> F -V <br /> 54�30 Phone: 1 (115) (05(0- 92.1.3 <br /> Original Parcel Information 9' <br /> 300 _. <br /> Parcel Identification#: 32 � �f�_Section�Township 41 N Range I( W e <br /> Original Description(or attach copy): 100 �� 31 1 3f(t 3q .100007 �a <br /> Current Zoning: R I_ Floodplain Y& N Wetland; <br /> k <br /> Lae/River Classification: `--�Name of Water Body: <br /> New Parcel Information T <br /> Proposed New Legal Description and Parcel Size: <br /> - Csm '1 lo•Is p <br /> Acres: 5.9 <br /> (if parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: L' <br /> Proposed access to public waters to be provided Y/N: --�� <br /> S <br /> If yes,describe access: O¢ <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> ➢ Does parcel require a Survey? Yes No <br /> ° 8 <br /> N O <br /> ➢ Permit application fees submitted? O Amount S Receipt# <br /> ae <br /> ❑ Wv <br /> e Reconciles With Real Property Lister Yes No Date: gyp <br /> CL <br /> RIf not,explain: 9 n <br /> Applicati o: Approved / nied Reason for Denial: $ <br /> p coo <br /> Land Use' <br /> se Date: ---jS <br /> 2/10003 <br />