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Burnett County Subdivision Permit Application Fes my -acraunp fey__ <br /> S division w/o Survey: <br /> and/or Pre-Application Form Subd,VIS oirw`Smvey $35 00{$5.00/lot <br /> Owner: �,. Anice �fllWl RJ1 J <br /> Address: '3�oanI s 54, CY'O j xk /y c"' 1 <br /> �JAflDltftl U�l �Y�o�U Phone: <br /> Original Parcel Information A <br /> Parcel Identification#: Sias-0 �Se� on_ �Township Range 3 <br /> z <br /> ° <br /> Original Description (or attach copy): <br /> N It 60, 330 J Scr C <br /> 00 <br /> 0 <br /> a Current Zoning: �� /Floodplain Y/N: Wetlands YIN: <br /> 9• Lake/River Classification: Name of Water Body: <br /> m <br /> 0 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> S 336 ( (A N &W 33ol <br /> SE- N L10 Acres: c2,/v1. <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: t� � 7. (?/ V �"/� r _. p <br /> Proposed access to public waters to be provided Y/N: Al v <br /> If yes,describe access: <br /> ��o,� <br /> � ➢ Does parcel meet Zoning Requirements? Yes No ��� C� 4� <br /> ➢ Does parcel require a Survey? Yes No Ve lUcL l <br /> no. <br /> o <br /> oa ((f p <br /> ➢ Permit application fees submitted? Amount$ 0,�� Receipt#N O��/ <br /> A <br /> r <br /> u <br /> 0 Reconciles With Real Property Listed <br /> ^ s NQ._____._ ate: c (A p <br /> c Ye <br /> If not, explain: � <br /> a <br /> N <br /> Applicatio Approved enied Reason for Denial: <br /> �2�2 V G�Li 7CQ �D� <br /> L" <br /> Gpp <br /> Land Use: Date: - dy <br /> 2/18/2003 <br />