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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 /> Subdivision w/Survey:$100.00+$15.0011ot <br /> Owner: `10 WJ 5V.a4-- <br /> Address: 2189 SYCAMOP-6 LN <br /> �l Ant.E Gf2o1/� M IJ S$ 369 Phone: 0 1 Z- 3106 - 77 <br /> o!g 3335 0Si�ZParcelInformation <br /> A <br /> Parcel Identification#: O S 1 00 <br /> Section 35 Township 39 Range 1_ e <br /> Original Description (or attach copy): A-frp c 44lsp <br /> .D <br /> __6r5 1 , z Pknr or 3 C S M ✓o L 15 P 19 o J <br /> Current Zoning: iZ� Floodplain YIN: 7 Wetlands Y/N• 14 <br /> Lake/River Classification: Name of Water Body: C LA.tt� L 1e <br /> m <br /> � c <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: Fa - b i d rS i ori d r t-OVS _ <br /> 1 , 7 , 3 Cf-SrvA- Vdw. ( S ) P190 <br /> Acres: <br /> (if parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: F3,/ p�SCsnr. <br /> Proposed access to public waters to be provided Y/N: G-1� G d <br /> If yes,describe access: <br /> ➢ Does parcel meet Zoning Requirement . Yes No <br /> 0 <br /> e ➢ Does parcel require a Survey? No A <br /> 0 <br /> oro 3 <br /> 0 <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> x <br /> ag <br /> o ❑ Reconciles With Real Property Lister Yes No Date: � <br /> o. � <br /> If not,explain: ww�' <br /> o Www <br /> Application pproved / D ied Reason for Denial: <br /> oQ <br /> Land Use t/ Date: L '�Y <br /> 2/18/2003 73 <br /> v' <br />