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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: 525.00+$5.00/lot <br /> Owner: / ilV�✓1 fi �c�2'�J M P i��� J <br /> Address: <br /> Phone: 7i5-�S�` 3� P� <br /> Original Parcel Information A <br /> Parcel Identification #: 2-4/D- 15-13-d 65 5 n 1.3 Township y4/tl Range 16-K/ 3 <br /> Z <br /> Original Description (or attach copy): G,1. (—xl <br /> Vol Z 4 4 & S-7 <br /> 40S/$3S <br /> o Current Zoning: R' Floodplain&N: Wetlands"�N::-� <br /> 9• Lake/River Classification: ta}1$S 2 Name of Water Body: %1ZU1 L <br /> m <br /> a <br /> New Parcel Information / <br /> Proposed New Legal Description and Parcel Size: U <br /> Acres: <br /> (If parcel is to be surveyed, provide preliminary map. See attached for preliminary" requirements.) <br /> 1! l 5` <br /> Proposed access to public road: %' r <br /> UV <br /> Proposed access to public waters to be provided YIN: — JUL my <br /> 2 8 <br /> If yes, describe access: A <br /> ➢ Does parcel meet Zoning Requirements? Ye No NG <br /> N l^ (y Q <br /> ➢ Does parcel require a Surrey? e NoS�JI� PaL o <br /> ➢ Permit application fees submitted. � Amount $ � ' � Receipt # e <br /> Reconciles With Real Property ListerYes No Date: O <br /> a <br /> aIf not, explain: <br /> a <br /> W <br /> Application: Approved Denied Reason for Denial: <br /> UJ <br /> Land Use: Date: 7-c9Le(-�� / <br /> 2/18/2003 CZ <br />