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Burnett County Subdivision Permit Application Fees(must accompany fonn): <br /> Subdivision w/o Survey: $10.00 <br /> and/or Pre-Application Form Subdivision wi Suncy:$100.00+$15.00/lot <br /> Owner: 64W6 FffsTI/V <br /> Address: _71c2_7 `IZZ" -511e. 211- t Al 6& Q- 612- _3a — e31,0 <br /> N k-do-61 7h/rL Phone: 451- '7L19- 61y66 <br /> A <br /> Original Parcel Information 2 <br /> Parcel Identi8t�1/ <br /> Identification#: Q 3-y-/5.�-�5- Dectiou �� Township ��//✓ Range � o <br /> Original Description(or attach copy): ALL bF LOT // e�/M V/9 <br /> 9 Current Zoning: /�� �- Floodplain Y6 Wetlands <br /> Lake/River Classification: <br /> ( dam Name of Water Body: Bl 6 -n-ap_ z&hlp, <br /> �f <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> A <br /> Acres: <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: k121 cyt 7a � <br /> Proposed access to public waters to be provided Y�T�•. <br /> m <br /> If yes,describe access: <br /> C,D <br /> ➢ Does parcel meet Zoning Requirements? No U <br /> N n <br /> °e ➢ Does parcel require a Survey? Yes No 'g <br /> o <br /> � e <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> it <br /> ❑ Reconciles With Real Property Lister Yes No Date: S <br /> C6 <br /> n If not,explain: 0� <br /> o <br /> CL <br /> y <br /> UJ <br /> Application: Approved / enied Reason for Denial: 4-7,n�f-- <br /> Land Use: <br /> 2/18/2003 <br />