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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: $10.00 <br /> and/or Pre-Application <br /> -Applicattion Form Subdivision wiSutvey:S100.00+SI5.00not <br /> M <br /> Owner: t l k r e k : Me-N A ! I V <br /> Address: So I W. 0 1,5 o A Or _ �� r r � M 41 a./ l y <br /> G(- avS <br /> �tpN.i-q WPhone: -71S - � �� - 3aoo <br /> n <br /> Orieinal Parcel Information W e5f <br /> 040-3633-01 -400 <br /> Parcel Identification#: 04 o-3635- 01 - '00 Section 3_5' Township J9 Range 19 <br /> Original Description(or attach copy): S h(y N W �4 a N W J4- ,S W <br /> O <br /> " ' 0 <br /> Current Zoning: /yO rl(?' Floodplain Y/N: �10 Wetlands Y/N: No '• <br /> 9 Lake/River Classification: Name of Water Body: — — <br /> o �- <br /> w <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: <br /> Q <br /> Acres: a 4Z <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: <br /> O <br /> e <br /> Proposed access to public waters to be provided Y/N: rA <br /> If yes,describe access: <br /> pr <br /> Does parcel meet Zoning Requirements? Yes No <br /> n <br /> ➢ Does parcel require a Survey? Yes No e <br /> C <br /> w ➢ Permit application fees submitted? ❑ Amount$ Receipt# <br /> x <br /> 00 <br /> 13Reconciles With Real Property Lister Yes No Date: US <br /> b <br /> a cN � <br /> If not,explain: 6W' <br /> a _ <br /> I f <br /> Application: Approv / Denied Reason for Denial: '� p <br /> Land Use: Date: <br /> 2/l8/2003 <br />