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Burnett County Subdivision Permit Application Leeest accompany form): <br /> ionw/oSurvey: $10.00 <br /> and/or Pre-Application Form ionw/Survey: $25.00+$5.00/lot <br /> Owner: "]&A4 <br /> Address: ` <br /> U "I �/ " �" 1� I p, <br /> `�u� Cl 7) U 5J 09 Phone: <br /> Orieinal Parcel Information ' r Iv <br /> Parcel Identification#: 3a-�a30-d�'Sfe�i� 30 Township �t Range �� 3 <br /> z <br /> Original Descrip ion (or attachcopy): E 1 1 5= y <br /> `t 6L <br /> Current Zoning: 3 Floodplain Y/N: Wetlan Is Y/N: <br /> Lake/River Classification: Q s S Name of Water Body: <br /> 0 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: l'eQSa <br /> PaU s at<� - <br /> S3(C:) S-/4-()q Acre : <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> Proposed access to public waters to be provided Y/N: y— s cy&e' d <br /> If yes,describe access: S&YYLQ �/ Qolc <br /> Q� <br /> ➢ Does parcel meet Zoning Requirements? Yes No b <br /> N <br /> ➢ Does parcel require a Survey? Yes No S/V 7 3 n <br /> ➢ Permit application fees submitted? C Amount$ -70- M Rece' t# - <br /> /' A <br /> r <br /> Reconciles With Real Property Lister Yes No Date: p <br /> If not,explain: U <br /> o <br /> a <br /> N <br /> Application: pproved Denied Reason for Denial: <br /> Land Use: Date: <br /> 2/18/2003 <br /> II <br />