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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: $10.00 <br /> and/yor� Pre-Application Form Subdivision w/Survey: $25.00+$5.00/lot <br /> / <br /> Owner: l r Ct:.(C K frau/p'_ <br /> Address: lO 3Q 9 X Road ,5 p90O - pJ;2 -X 86 U U.ZkA <br /> 01-Pd ", AA/ 55y38 Phone: / �a " / 10- -615 3 y <br /> Original Parcel Information <br /> ��0 3 <br /> Parcel Identification #: 11U�X�I 1 Section 2 d Township y <br /> Range <br /> Z <br /> Original Description (or attach cop)): _ ME ��L/ Al r YNJD ALAI AV <br /> - o-? BD / 7Z/ <br /> po <br /> Current Zonin /l o� Floodplain Y N�c� NVedands Y ; / <br /> 'o <br /> Lake/River Classi tca ton: Name of Nater Body: <br /> m � <br /> 0 <br /> p <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: Z C5-rn $ <br /> S�o�"s <br /> Acres: 3 Go ± <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: N. F U LLf'i-H t 1 V C . <br /> Proposed access to public waters to be provided YC p <br /> If yes,describe access: <br /> 0.� <br /> ➢ Does parcel meet Zoning Requirements? Yes No of <br /> N <br /> ➢ Does parcel require a Surrey? Yes No A <br /> o <br /> 00 3 <br /> ➢ Permit application fees submitted? ❑ Amount S Receipt # <br /> 0 <br /> ❑ Reconciles Willi Real Property Lister Yes No Date: 0 0 <br /> If not, explain: c <br /> o w W <br /> 0. C L <br /> y g LV <br /> e <br /> n <br /> Application Approved Denied Reason for Denial: <br /> C � <br /> Land Use: Date: <br /> 2/18/2003 <br />