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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:$100.00+$15.00not <br /> Owner: e A L yD� ll/Zst�ST <br /> Address: 33¢98 ljeizr!! GA�cES/rb?� D/r• <br /> Jc/i4DW% 1> zL, roco3p Phone: 8,47- ZZ3-A3-4zS <br /> A <br /> OdizinalParcelInformation <br /> 020 -0 33o- <br /> Parcel Identification#:ozo -¢3/0 -c:,1o 7oSection /o Township 4c� Ranged_ o <br /> nzo- ¢3/o-o/dodo o <br /> Original Description (or attach copy): <br /> SSE A7 TAGNE M, <br /> pi4/LGE L 3 <br /> s Current zoning: ax-z- Floodplain Y/N: �� Wetlands Y/N: <br /> ;; Lake/River Classification: G4455 Z Name of Water Body: /d:P.IE <br /> Z/9X-E <br /> oo <br /> p <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Siz � �9L <br /> 0 <br /> _...n cres• <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: �a <br /> m <br /> Proposed access to public waters to be provided Y/N: g <br /> If yes,describe access: <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> N 11 <br /> ➢ Does parcel require a Survey? Yes No °g <br /> p=p D <br /> ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> at: <br /> e ❑ Reconciles With Real Property List Yes No Date: 4S o o <br /> a <br /> If not,explain: P W <br /> aVN <br /> cw <br /> w OIN <br /> Jo <br /> ApplicatioApprove / Denied Reason for Denial: o <br /> poo <br /> Land Use: Date: <br /> 2/18/2003 <br />