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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: $25.00+$5.0onat <br /> Owner: ��L/�eJ` aw ,/ SM-5 //V <br /> Address: 7py�5,� J�Q/I h zatl(le <br /> Phone: <br /> U Orieinal Parcel Information <br /> Parcel Identification#: L) Section 5 Township Jf4l Range �J 3 <br /> �, c" z <br /> Original Description (or attach copy): (% <br /> v <br /> Q <br /> O <br /> Current Zoning: FloodplaiY T: Wetland&N: <br /> g, <br /> oe <br /> Lake/River Classification:_�rs/ Name of Water Body: V t L A <br /> e <br /> w <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: _ _ ems`/7? 'f'�.e'J <br /> c;L 3/ q Cam I i9 felSte- /S l <br /> Acres: �, G <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: _ 1091 b cLe d c Le u <br /> Proposed access to public waters to be provided Y/N: 3 e. Cs m <br /> If yes,describe access: /V a rn< <br /> e, ➢ Does parcel meet Zoning Requirements Yes 1 No <br /> ➢ Does parcel require a Survey? Yes No Tj <br /> as <br /> ➢ Permit application fees submitted., ❑ Amount$ ( ✓' Receipt# <br /> w <br /> A <br /> 7 <br /> r ?� <br /> Reconciles With Real Property Lister Yes No Date: <br /> 6 <br /> If not, explain: 'C <br /> o � <br /> a <br /> N <br /> Ck(� <br /> I <br /> Application. rov enied Reason for Denial: i <br /> n <br /> Land Use: Date <br /> a3 <br /> 2/18/2003 ✓� <br />