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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 pForm Subdivision wi Survey:sioo.00+sis.owt <br /> Owner: iA44w. Y �ir .L, (Srree`� <br /> Address: 5 G, y L�L? 3 <br /> —L2 3 Phone: (,7i.�� lv!o — y 7 Y,� <br /> A <br /> Original Parcel Information 3 <br /> Parcel Identification#: v 1 33aD o3'yation D--y Township 3 Range 1 (o 0 <br /> Original Description (or attach copy): S '/ GLS Art 0%y <br /> r�Q q la 9 <br /> y Current Zoning: FloodplaY Wetlan s Y <br /> v � <br /> • Lake/River Classification: Name of Water Body: C ow,ti 1 L) r <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: S U) <br /> ' <br /> p <br /> 4,44 11 <br /> S uJ / <br /> Acres: Ly C) <br /> [Proposed <br /> f parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> roposed access to public road: J <br /> v <br /> access to public waters to be provided Y/N: (A <br /> If yes,describe access: A) /I Y{ <br /> pi <br /> ➢ Does parcel meet Zoning Requirements? Yes No <br /> 0 <br /> e ➢ Does parcel require a Survey? Yes No g <br /> 0 <br /> 00 0 <br /> ➢ Permit application fees submitted? ❑ Amount,S Receipt# <br /> �r <br /> p o <br /> a ❑ Reconciles With Real Property Lister Yes Date: <br /> eIf not,explain: <br /> I <br /> W VV <br /> Application: Approved / euied Reason for Denial: C W <br /> 0 <br /> Land Use: Date: <br /> 2/18/2003 <br />