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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:$100.00+$15.00Aot <br /> Owner: <br /> Address: e4L16r" S% /, <br /> �� ( Phone: ?15—(.9V6— 97dC) <br /> C-elc- 7lS-7,Y - I yo , <br /> A <br /> Orkinal Parcel Information 3 <br /> Parcel Identification#: 33 )3-0- Section Township Range�� o <br /> Original Description (or attach copy): /t/W <br /> D� <br /> O <br /> > Current Zoning: Ellq 14wodplain Y/N: a1 Wetlands Y/N: <br /> e � <br /> '— Lake/River Classification: Name of Water Body: <br /> n <br /> m S <br /> e <br /> .. a <br /> New Parcel Information / <br /> Proposed New Legal Desert tion and Parcel Size: A/l�„ / 1A,1 <br /> 0> 2 X. <br /> n 1 <br /> L d'��C)N /1/wll S'r i� CSV x Acres: 5 A <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) S <br /> Proposed access to public road: &Ay RIS X <br /> v <br /> Proposed access to public waters to be provided Y/N: _ / /y <br /> If yes, describe access: <br /> G <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N n <br /> °o ➢ Does parcel require a Survey? Yes No G 3 <br /> ➢ Permit application fees submitted? ❑ Amount$1 00 Receipt# S �Y7 <br /> a <br /> r <br /> ❑ Reconciles With Real Property Liste Yes No Date: <br /> a <br /> CN <br /> If not,explain: � <br /> o <br /> C6 W <br /> O <br /> Application: (�pproved Denied Reason for Denial: 9� <br /> bo <br /> Land Use: / ((Date: <br /> 2/18/2003 <br />