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Burnett County Subdivision Permit Application Fees(must accompmy form): <br /> and/or Pre-Application Form Subdivision w/o Survey: 510.00 <br /> Subdivision w/Survey:s100.o0+s15.00not <br /> Owner: MtK'Y•i4 MCD OjLk� 1r <br /> Address: 7150 CU Romd <br /> �atnb� W I 5'i g 30 Phone: 1 (115) (05(0- 3213 <br /> Orieinal Parcel InformationSoo <br /> 9 <br /> Parcel Identification#: a2=7L'Z_ 5-Q5� Section 2% Township'Range I6V) o <br /> Original Description (or attach copy): 1*0 1.o1 31 i 3V i 3°I PC.77 � <br /> /U <br /> - <br /> Current Zoning: _ R ( Floodplain Y,�1• _n� Wetland - <br /> ; y_ <br /> v <br /> `• Lake/River Classification: Name of Water Body: <br /> e <br /> New Parcel Information T <br /> Proposed New Legal Description and Parcel Size: 1 - H Ib� C-SM <br /> - Csm <br /> b <br /> Acres: 5.9 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: S'h ow H <br /> Proposed access to public waters to be provided Y/N: <br /> n <br /> If yes,describe access: oQ <br /> ➢ Does parcel meet Zoning Requirements? Yes No i <br /> e <br /> Does parcel require a Survey? Yes No 9 <br /> e <br /> ➢ Permit application fees submitted? ❑ Amount S Receipt# <br /> a <br /> ❑ Reconciles With Real Property Lister Yes NoDate: aka <br /> a <br /> � 9�vU <br /> R If not,explain: <br /> a v Z% <br /> �IH <br /> OR <br /> Applicata n: Approved / nied Reason for Denial: $ <br /> Land Use: <br /> Date: j- <br /> 2/19/2003 <br />