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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> and/or Pre-Application Form Subdivision w/o Survey: $10.00 <br /> PP Subdivision w/Survey:$100.00+$1S.Oo/lot <br /> Owner: a WJ 5-VAC-- <br /> Address: <br /> VA--Address: ,9189 SVCAM6Q,6 LN tj <br /> SLE G►2011tr M IJ S$' 3ro 9 Phone: 45 1z- 3916 - 77 t3 <br /> 01£3 3335 OoS mgl.Parcel Information <br /> A <br /> Parcel Identification#: 05 I oo Section 35 Township 39 Range <br /> Original Description (or attach copy): A rA-c 44 15�P <br /> CATs I , Z PA>ZT- OF, 3 c s M ✓o c. 15 P l 9 o J <br /> '7 4A <br /> Current Zoning: rL Flood lain Y/N: f 9 <br /> �-- P Wetlands Y/N: <br /> Lake/River Classification: Name of Water Body: G LAM t 1< -� <br /> � o <br /> S <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: RI's - D t t/ is i ujn d F L.aT'$ <br /> 1 Z 3 cSnti- dd4-- Is I-'190 <br /> Acres: <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: Ex(S in 0 <br /> G <br /> If yes,describe access: <br /> �.1 <br /> ➢ Does parcel meet Zoning Requirement . � " Yes No d <br /> N L <br /> ➢ Does parcel require a Survey? —r—� No 0 <br /> a°a 3 <br /> C <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# R <br /> A <br /> xc <br /> m ❑ Reconciles With Real° Property Lister Yes <br /> No Date: <br /> ' <br /> If not,explain: WW <br /> C `�v�w <br /> y iLl <br /> Application• pproved / D ied Reason for Denial: 1° <br /> 00 <br /> Land Use: <br /> ZZ <br /> Date: <br /> 2/18/2003 (?�SA 73 <br />