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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 F-�orrm) Subdivision w/Survey: $25.00+$5.00/lot <br /> Owner: >°LtX�/Gl( � <br /> Address: in / p <br /> D'1�1-11//Ja � 87(, /`U <br /> � Phone: � 9 498 <br /> Original Parcel Information A <br /> ' D 3 <br /> Parcel Identification#: 630-1G_4,- U 3-9Aection J/c�) Township 37 Range z <br /> Original Description(or attach copy): P z 1'r-) !'VLA) S <br /> J <br /> /1 O <br /> Current Zoning: Tr-,� Floodplain Y/N: 0 Wetlands Y/N: PS <br /> ra�eRiver Classification: 3 Name of Water Body: !/Lo0 IL �-21K-2 , <br /> a � <br /> o rlz� <br /> w <br /> New Parcel Information <br /> ( <br /> Proposed New Legal Description and Parcel Size: x/21 V I q <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: — d <br /> A <br /> If yes,describe access: <br /> v <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N <br /> °o ➢ Does parcel require a Survey? Yes No e <br /> 5 B <br /> � D <br /> ➢ Permit application fees submitted? Amount$ L10• LOd Receipt# 39, 7 c <br /> A <br /> aReconciles With Real Property Lister Yes No Date: <br /> If not,explain: <br /> o <br /> 6 \ <br /> Vi <br /> Application: Approved Denied Reason for Denial: <br /> I <br /> Land Use: �! Date: ��-�� Q oZ <br /> 2/18/2003 <br />