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Burnett County Subdivision Permit Application Fees(must accompany forth): <br /> Subdivision w/o Survey: $10.00 <br /> and//or Pre-Application Form Subdivision w/Survey: $25.00+$5.00/lot <br /> l <br /> Owner: �� II Ja of E <br /> Address: 1ZS-1 Wj(dCoAfsi Cuoj/< <br /> CAMP to M h SSI 2 3 Phone: �,51 —4SZ- Z 4S7 <br /> $143 2& L e 0 Areo <br /> Original Parcel Information A <br /> 032-s215-os-iooU D5W <br /> Parcel Identification#:n-3,m-Gzj jr os uoo Section�Township /lk Range <br /> z <br /> 0 <br /> Original Description (or attach copy): <br /> CA <br /> _9�) <br /> po <br /> Current Zoning: 2 Floodplain(gN: Wetlands(qN: <br /> 0 <br /> V• Lake/River Classification: C� f Name of Water Body: 73 <br /> �i76/Cxlil/G�(7/!1[Q <br /> c <br /> New Parcel InAfrormation�}C_SM ✓ 6 t,)L 39 a qb <br /> Proposed New Legal Description and Parcel Size: 2 L-4-) t <br /> 1-61- l 0601 V l/ p /ZO-/Z/ 467`a . C31n V <br /> 189 - l 96 - rpczo sw SGV �� Acres: Z• zy <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) r <br /> Proposed access to public road: �6 <br /> Proposed access to public waters to be provide: <br /> If yes,describe access: d <br /> N ➢ Does parcel meet Zoning Requirements? aa <br /> No 7-r <br /> QUJV� O <br /> °o ➢ Does parcel require a Survey? No G <br /> ao <br /> , <br /> ➢ Permit application fees submitted? ,J Amount S !3 Receipt# esw` c <br /> m <br /> �t <br /> m Reconciles With Real Property Lister Yes No Date: C> <br /> If not,explain: <br /> Q <br /> a �\1 <br /> Application: Approved )/ enied Reason for Denial: (� <br /> r (p, <br /> Land Use: Date: I ' (3✓� C <br /> 2/18/2003 <br />