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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+$5.00/1ot <br /> Owner: :.oNNitr JnC 00mir-i Ng <br /> Address: p, a Bolt 15 Z-3 <br /> V4Gi3sTm-t_ i j-E 3 Phone: 866 8-LO (o <br /> Original Parcel Information <br /> Parcel Identification#:016-33 I4-©-z,3o a3 <br /> Section 14 Township 3 9 Range <br /> 0 <br /> Original Description (or attach copy): 5-EC " <br /> 71) <br /> .A <br /> J <br /> m <br /> 4", <br /> O <br /> a Current Zoning: P-R--z Floodplain Y/N: tJ Wetlands Y/N: <br /> • Lake/River Classification: Z Name of Water Body: $ftSS L ASE <br /> ar <br /> to <br /> New Parcel Information 3 <br /> Proposed New Legal Description and Parcel Size: Z_ Lo c.S M <br /> h <br /> L 9 -tarA�L_ <br /> Acres: L9 <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: No Bass !Io <br /> Proposed access to public waters to be provided YIN: _` d <br /> ro <br /> If yes, describe access: Z-Aku Sffo2ir; LTJ <br /> Q� <br /> g <br /> N ➢ Does parcel meet Zoning Requirements? Yes No <br /> °o ➢ Does parcel require a Survey? Yes No c <br /> w' 3 <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> n <br /> ti <br /> t^ <br /> ❑ Reconciles With Real Property Lister Yes No Date: p <br /> a � <br /> ;a If not,explain: <br /> n <br /> o W <br /> n. W <br /> Vl � <br /> Applicatio Approved / enied Reason for Denial: <br /> / 4 <br /> Land Use Date: <br /> 2/18/2003 <br />