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Burnett County Subdivision Permit Application Fees(must accompany form); <br /> and/or Pre-A libation Form subdivision w/o survey: $10.00 <br /> PP Subdivision w/Survey:$100.00+S I5.00Aot <br /> Owner: 'PAaM �u,vn/ <br /> Address: Zoo �. G rr-w&s k <br /> SHetr� �a��� t,✓s s4s�I Phone: ir/f- *6b - #obS <br /> A <br /> Original Parcel Information B <br /> Parcel Identiflcation#: 01-200 � .I- Soo Section_3 Township 38 Range / e <br /> Original Description(or attach copy): _�,l T o` THE N I,.!IA/e +p —A -r o,c <br /> �i�F_ SI,/�/y�' of SirGT/..✓ !3 Tew.y oG G.aFeLL�. �E � <br /> CurrentZoning: t' Floodplain Y/N: <br /> P Wetlands/�/N: <br /> k ver Classification: l'_Gas5 3 Name of Water Body: L4N,4a4sC <br /> r <br /> 4 <br /> New Parcel Information <br /> A <br /> Proposed New Legal Description and Parcel Size: A5 Pe-,&- C. sr. M. p <br /> 3 <br /> Acres: 3%. 3 g-a <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: A rw y y C,.u.vey Relic <br /> Proposed access to public waters to be provided Y/N: ti <br /> If yes,describe access: <br /> d <br /> Does parcel meet Zoning Requirements? Yes No <br /> o <br /> Does parcel require a Survey? Yes No g <br /> ➢ Permit application fees submitted? O Amount$ Receipt# <br /> t. u <br /> 0 Reconciles With Real Property Lister Yes No Date: <br /> It not,explain: w <br /> 0 <br /> o _ <br /> Applicatio App / Denied Reason for Denial: O o <br /> O <br /> Land Use: <br /> Date: <br /> 2/182003 <br />