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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+$5.0011ot <br /> Owner: /4GTE/2 �ILETSGf1o+/r C 4-ce 42�2 <br /> Address: 35&+ <br /> �vcc�Eic�o� y✓i . 580 Phone: � O LQ1/1X 1)lbr . <br /> Original Parcel Information <br /> 3 <br /> Parcel Identification #: e:_1-5Z_ .S7_/7497_9&qgection /7 Township 4,1 —Range <br /> Original Description (or attach copy): � jzgeoZ P¢9� <br /> O <br /> /o <br /> Current Zoning: /Z 2 Z Floodplain Y/N: N Wetlands Y/N: lJo A <br /> Lake/River Classification: G'�15 5 d— Name of Water Body: lW oO 72 LAX 6 <br /> m <br /> 0 <br /> New Parcel Information CS Y-n V P) <br /> Proposed New Legal Description and Parcel Size: JA/- PIE <br /> X <br /> C—_4- Acres: 62 �'Cs � <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: yF5 -r196&V f- <br /> Proposed access to public waters to be provided Y/N: <br /> d <br /> If yes, describe access: �1/v. G//✓� vJ/lt`�'/',��1' dQ <br /> ➢ Does parcel meet Zoning Requirements? No <br /> N <br /> °o ➢ Does parcel require a Survey? Y No c <br /> 3 <br /> ao <br /> ➢ Permit application fees submitted? � Amount$ � ' Receipt # q <br /> �3 a <br /> A <br /> at <br /> r <br /> � Reconciles With Real Property ListerYes No Date: <br /> a <br /> :0If not,explain: <br /> o LA <br /> a <br /> y <br /> - J <br /> Applicatio : Approved Denied Reason for Denial: <br /> Land Use: Date: <br /> 2/18/2003 <br />