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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+$5.00/lot <br /> �ll <br /> Owner: PA <br /> Address: / 03 4ue- /L/- /_ ��/ (, <br /> 1 41cc h- a M4-., '!5'56 '_/c9 Phone: OSI- 276' l! f <br /> Orieinal Parcel Information A <br /> p LIQ <br /> Parcel Identification#: G c� - Ll/6�- ��-a- ection 8 Township Range ) L z <br /> n / o <br /> Original Description(or attach copy): <br /> Q <br /> CIO <br /> O <br /> Current Zoning: R-a - Floodplain Y/N: �_ Wetlands Y/N: `_ <br /> �• Lake/River Classification: / Name of Water Body: �Sh L K <br /> m <br /> 0 <br /> New Parcel Information �[ <br /> Proposed New Legal Description and Parcel Size: <br /> Acres: Atym 2 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Prtua -�C (2 //` <br /> Proposed access to public waters to be provide Y t S`r{1 <br /> wa <br /> If yes, describe access: P / <br /> ewzg <br /> nn1` <br /> ➢ Does parcel meet Zoning Requirements? Yes5No <br /> N � VJ <br /> °o ➢ Does parcel require a Survey? Yes 0 <br /> 5 3 <br /> ➢ Permit application fees submitted? /\ Amount$ Q� Receipt# <br /> A <br /> x <br /> m 0 Reconciles With Real Property Lister Yes No Date: C) <br /> a oe <br /> If not, explain: <br /> 0 0 <br /> a t <br /> H <br /> 01 <br /> Applicatioq Approved / vied Reason for Denial: <br /> / ,�. <br /> Land Use: �vz'�l�Gi•�—� Date: <br /> — C <br /> 2/18/2003 G' <br />