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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: $25.00+$5.00/lot <br /> p <br /> Owner: rAT {}gy�ppN 0E/2s0&f <br /> Address: 76 0 S t o wl p j A v< <br /> r <br /> 194N6uitr U/Ls' Phone: F"-` -fo <br /> Orieinal Parcel Information , / <br /> Parcel Identification #: 20-4/P6 -oZ-7oe Section Zy Township L14A Range <br /> 1 z <br /> Original Description (or attach copy): Lof l3 Vt alt r o7p au 44 ,cIeiJrr,TP o <br /> p 0 <br /> Current Zoning: R Floodplain Y I Wetland&N: <br /> �• Lake/River Classification: Name of Water Body: <br /> m <br /> 0 <br /> New Parcel Information r <br /> Proposed New Legal Description and Parcel Size: <br /> CS-M W <br /> Acres: "7 b <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: PeeSPa.E <br /> Proposed access to public waters to be provided Yo wv <br /> A <br /> If yes, describe access: <br /> ➢ Does parcel meet Zoning Requiremen . Yes No o- <br /> ➢ Does parcel require a Sw-ve),? C 'Yes No c <br /> ➢ Permit application fees submitted? Amount$ Lls Receipt # °e <br /> A <br /> log <br /> a <br /> Reconciles With Real Property Lister Yes No Date: C>„ <br /> a <br /> If not, explain: <br /> 0 <br /> , <br /> H <br /> W <br /> Q <br /> Application( Approved / enied Reason for Denial: <br /> ? —oy <br /> Land Use: Dale: J ' <br /> 2/18/2003 �� 17&1) S774&-�p <br />