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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+$5.00/lot <br /> Owner: bI/EOU16e- <br /> Address: Z 4 /7 '-1 C-t-/ /Lc/ 4 <br /> 5�200N rl LV/ C5,7a 1 Phone: 715-4o3 _ 560 <br /> Original Parcel Information <br /> m9 <br /> Parcel Identification#: Section Township 39V Range 10V 8 <br /> �` -� o <br /> Original Description (or attach copy): T�y�r�W IV W C <br /> W& e4 A <br /> Ez <br /> Current Zoning: 'Z. Floodplain Y6 Wetlands S o � <br /> 0 <br /> '— Lake/River Classification: Name of Water Body: , <br /> m <br /> 0 <br /> w <br /> New Parcel Information <br /> Proposed New Legal Desc777nd Parcel Size: e w S/f*,? <br /> Acres: L135d <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: e_xw <br /> Proposed access to public waters to be provided C <br /> w <br /> If yes,describe access: A <br /> ➢ Does parcel meet Zoning Requirement Yes No <br /> N c <br /> ➢ Does parcel require a Survey? Yes No n� <br /> °O / / 3 <br /> ➢ Permit application fees submitted? ount"$ y� Receipt# 7 O <br /> A <br /> Reconciles With Real Property Liser es No Date: <br /> a <br /> If not, explain: <br /> N <br /> v� <br /> Application Apr / Denied Reason for Denial: zo, COC/ <br /> Land Use: Date: <br /> 2/18/2003 <br />