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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+$5.00/lot <br /> Owner: <'Cr --rbC POM INA,S <br /> Address: ga� 5 Z.3 <br /> kJ t--��Srr�/L b✓ L 5+6,13 Phone: 666 82.042 <br /> Original Parcel Information <br /> 3 <br /> Parcel Identification#: IS 33 I Q—oZ 30o Section 14" Township 3? Range& z <br /> 0 <br /> Original Description (or attach copy): S2Gm t oy <br /> W <br /> O <br /> Current Zoning: YL 2� Floodplain Y/N: r1l Wetlands Y/N: <br /> t <br /> Lake/River Classification: y Name of Water Body: 13 PASS L k- <br /> 0 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: 1 Loi 1 ? A crz-ES <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: Alli . BASS e-*-0' /Z-J> <br /> Proposed access to public waters to be provided YIN: d <br /> A <br /> If yes,describe access: D I IZ+T CT' <br /> ➢ Does parcel meet Zoning Requirements? Yes` No <br /> N <br /> o ➢ Does parcel require a Survey? Yes No 0 <br /> � <br /> ➢ Permit application fees submitted? Amount$ ��' v U Receipt# 4-33 'c <br /> Reconciles With Real Property Lister es No Date: El_ <br /> If not,explain: Ua <br /> a Z <br /> Application Approved)/ Denied Reason for Denial: SL <br /> Land Use: f — Date: <br /> U <br /> 2/18/2003 <br />