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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 <br /> ^ Subdivision w/Survey: $25.00+$5.0011ot <br /> Owner: L0 tj GLA 5- a-d 6 C( QIC f'f &lEk <br /> Y1733 <br /> Address: 417.33 V H_ y?wA/n <br /> Phone: 715— 6 56 —7 3-75 <br /> Z_qe /y- 0 _ d,7epl /o Original Parcel Information <br /> 07760 / / 17W3 <br /> Parcel Identification #: �'y�- /'7-/y-G?" Section Township �6A Range <br /> z <br /> Original Description (or attach copy): L. y Lo CS V I I'Z J°1 jld <br /> p <br /> RR-/ o <br /> Current Zonin Floodplain Y� Wetlands Y0 <br /> 9• Lake/River Classt ' on: 2' Name of Water Body: <br /> d O <br /> 0 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> G n <br /> Acres: // p Q <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br /> / <br /> Proposed access to public road: �0'�yt/�(j li / &/,h _ <br /> Proposed access to public waters to be provided LAi> t7 <br /> d <br /> If yes, describe access: <br /> -L_ <br /> ➢ Does parcel meet Zoning Requiremen 2 NO ©) <br /> M. ➢ Does parcel require a Survey? Yes No e <br /> aro 3 <br /> ➢ Permit application fees submitted? O Amount $ Receipt # °e <br /> A <br /> xc <br /> ❑ Reconciles With Real Property Lister Yes No Date: o 0 <br /> c,. w <br /> a � � <br /> A <br /> If not, explain: <br /> o C. L <br /> N i r <br /> Q Q <br /> Applicatiot : Approved / nied Reason for Denial: <br /> o � <br /> 0 <br /> Land Use: Date: <br /> 2/18/2003 <br />