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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+$5.00/lot <br /> Owner: .9 Lyo.✓ T.dtGST <br /> Address: 3319 8 LA,1[ s.�fortE D,Q. <br /> ZG 4e0-d73y Phone: .9"7 - ZZJj <br /> Original Parcel Information A <br /> azo- �a3'n33�p � ,'�� <br /> Parcel Identification #:O ZD-43/0 -a/7o0 Section�Township�Range <br /> v z.o -4310—0'1 coco e <br /> Original Description (or attach copy): D /'1I e/' <br /> t-.9xcgFZ' 3 <br /> ID <br /> 0 <br /> > Current Zoning: 4 - Floodplain Y/N: /V Wetlands Y/N: _ <br /> �• Lake/River Classification:A L)G 55 Name of Water Body: LmY6 L IXl ' <br /> m \ <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: SE6 14rr09_-_WE7> /5�r2qC <br /> s <br /> Acres: <br /> i` <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: ND <br /> Proposed access to public waters to be provided Y/N: 1441P d <br /> m <br /> A <br /> If yes, describe access: <br /> OO <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> �• ➢ Does parcel require a Survey? Yes No 0 <br /> 00 3 <br /> ➢ Permit application fees submitted? ❑ Amount$ l Receipt # <br /> A <br /> x <br /> ❑ Reconciles With R1 Property Lister Yes No Date: <br /> C6 p o <br /> If not,explain: t <br /> WW <br /> a o` W <br /> °O W <br /> Applicatio Appro / Denied Reason for Denial: op c <br /> CIOG <br /> Land Use: Date: s <br /> 2/18/2003 <br />