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Burnett County Subdivision Permit Application pees(must accompany form): <br /> Subdivision./o Survey: $10.00 <br /> IJ <br /> and/or Pre-Application Form Subdivision w/Sumy:S100.00+515.00/lot <br /> Owner. / I aTL2 Co.,p JQ ul 10- <br /> Address: �T7O CKd 'A p / / �1 <br /> WQ bsker, tA,/i 5 y 893 Phone: 76" 067 - I b0S <br /> A <br /> 40N-13o3-ozIco OriuinalPanel Information ap / 9 <br /> Parcel Identification#:+019-3392­61566 Section 3 Township 39 Range lb o <br /> Original Description(or attach copy): ALL &F L61- 3, C 5M ✓ 6 <br /> G. L. <br /> Ckis� rs� Pa.c f o <br /> 4Current Zoning: Pon Floodplain''N: Wett�laod�YJN: .s'. <br /> Lake/River Classification: IJ <br /> � ? Name of Water Body: Oe v, S LCI KQ b <br /> 'm <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: C moo' <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: 1 tq <br /> 0 <br /> Proposed access to public waters to be providedC5 A <br /> If yes,describe access: ?Vl ' I '1 <br /> p� <br /> ➢ Does parcel meet Zoning Requirement . Yes No <br /> N n <br /> 'n ➢ Does parcel require a Survey? —Yew No B <br /> is D <br /> C <br /> D Permit application fees submitted? ❑ Amount$ Receipt# 8 1 <br /> u <br /> e ❑ Reconciles With Real Property Lister Yes No Dale: — O <br /> n <br /> 7d <br /> g If not,explain: <br /> a w � <br /> w c� <br /> o <br /> Applicatio • Approve / Denied Reason for Denial: <br /> n d <br /> n G <br /> Land Use: Date: <br /> 2/18/2003 <br />