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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision who Survey: $10.00 <br /> and/or Pre-Application Form Subdivision wiSurvey:$100.00+$15.aonot <br /> / <br /> Owner: t a l i-tcAe,11 /)'U U 1/e r <br /> Address: 6509 'IYm Gl ue. AK <br /> &-000AI /4J MW591,&Phoae: 74 3-566- 8933 <br /> Original Parcel Information <br /> Parcel Identification#:632-5-?3V-0446 Section 23q _Township yI Range 16UJ P <br /> Z2—Original Description(or attach copy): w /y sE&)l4/ � <br /> oo, <br /> Zoning:Current p. <br /> � g. R3 Floodplain Y/N: Wetlands Y/N: Z <br /> Lake/River Classification: Name of Water Body: E A G LE " Lh-KE �= <br /> w - z <br /> New Parcel Information b <br /> Proposed New Legal Description and Parcel Size: L/1.?n p <br /> a <br /> Acres: <br /> �e <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: _ EA6 LA KE Rb 0, <br /> D <br /> Proposed access to public waters to be provided Y/N: 6 <br /> If yes,describe access <br /> O <br /> ➢ Does parcel meet Zoning Requirements? Y No 6 <br /> e <br /> � ➢ Does parcel require a Survey? Yes ' No g <br /> � e <br /> q a <br /> ➢ 'Permit application fees submitted? O Amount S JL 0 0 Receipt# (Sa '1 l <br /> MENx <br /> GG <br /> ❑ Reconciles With Real Property Lister Yes No Date: v U <br /> If not,explain: 1ICr <br /> a wW <br /> Application Approv I Denied Reason for Denial: <br /> G <br /> aG <br /> Land Use: Date: <br /> 2/18/2003 �� <br />