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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�r� Subdivision w/Survey:$100.00+$15.00/lot <br /> Owner. �AKICE IZ -7E�2DhI�E_F pR1EN <br /> Address: 912 E-AsT V-,q1(N !RM E _ <br /> �Sv�PERllf1Z, W.4 544 TM 3SS7Phone: , lS--_�Rti-nlLC��r) <br /> A <br /> Oriainal Parcel Information 3 <br /> O2I&-f--llst0 = <br /> Parcel Identification#: OMS-1-4130-OI SCOSection_2>41) Township Range�_ e <br /> O -rd 13x-01 00 <br /> Original Description (or attach copy): <br /> tea. <br /> 0 <br /> > Current Zoning: lZR-17) — Floodplain Y/N: N Wetlands Y/N: <br /> e <br /> g <br /> Lake/River Classification:�!�[�_ Name of Water Body: TR O <br /> New Parcel Information y <br /> Proposed New Legal Description and Parcel Size: <br /> 'S f gL aj0 `Lr=\ Q <br /> Acres: M <br /> N' <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) Z <br /> Proposed access to public road: NOIyIF- <br /> m <br /> Proposed access to public waters to be provided Y/N: �_ g <br /> If yes,describe access: <br /> c <br /> ➢ Does parcel meet Zoning Requirements? "res No <br /> n <br /> o ➢ Does parcel require a Survey? Yes No 'g <br /> O C <br /> � C <br /> ➢ Permit application fees submitted? ❑ Amount$I D, O D Receipt# Sd goZ <br /> a <br /> o O Reconciles With Real Property Liste Y No Date: 3 3 O (A <br /> i�VL will mer \ v� ks (ASL MO0.\ �h c -�A-Q_ \>�cs>mes 1'� z^ <br /> If not,explain �Q1MOT Cn A CA Q, tDn Q <br /> o \ tN lu <br /> C <br /> w 4 �eew. dtz , 000 <br /> � q_o <br /> T <br /> Applicatio Approved Denied Reason for Denial: <br /> Land Use Date: <br /> 2/18/2003 <br />