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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:$100.00+$15.00Aot <br /> Owner: BUrz.NStr CouniTY <br /> Address: c�o TAKE mcpaus <br /> 74z.T Cau"j:j tZ.D K Phone: 715- - Z 15 l <br /> 51 agrj y 4 z— b <br /> Orieinal Parcel Information 'g <br /> , t&WAW64lk`0,2 -S3a4 -0I-IGU Section Z—Township 41 Range I5 0 <br /> Original Description(or attach copy): A="ct+0'l7> (D <br /> J <br /> 0 <br /> P��Osy :' Floodplain Y/N: rJ Wetlands Y/N: tJ o •'• <br /> g <br /> kation: NDi of N $pdy: 11 D/LQ <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: I LOT CSN( <br /> Acres: z z.-7 P, <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: L&r-G5 DRt V r=r <br /> v <br /> Proposed access to public waters to be provided Y/N: 00 A <br /> If yes,describe access: <br /> 0 <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N A <br /> ➢ Does parcel require a Survey? Yes No 3 <br /> o°a °e <br /> ➢ Permit application fees submitted? ❑ Amount S d Receipt#5;r) <br /> a <br /> o <br /> o ❑ Reconciles With Real Property Lister Yes No Date: W <br /> C6 9� <br /> oIf not,explain: <br /> a <br /> 0 <br /> 1 <br /> Application: Approved / Denied Reason for Denial: o <br /> v <br /> Land Use: Date: <br /> 2/18/2003 <br />