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Burnett County Subdivision Permit Application Fees(must accompany form): <br /> Subdivision w/o Survey: S10.00 <br /> and/or(Pre-Application Form Subdivision w/Survey: $25.00+$5.00not <br /> Owner: WPn�r'K��,,�10f l5k L' L' <br /> Address: <br /> Phone. -7 <br /> Original Parcel Information o� <br /> Parcel Identification#: 61& -34A- 65--960 Section Township 3 ( Range r 3 <br /> Original Description (or attach copy): S cc `S� ��C' 3-� �5— o <br /> � <br /> i <br /> q Current Zoning: l,(A/Zvilcd Floodplain I Wetland <br /> '— Lake/River Classification: /U Name of Water Body /l1 <br /> m <br /> 0 <br /> New Parcel Information <br /> Proposed New Legal Description and Parcel Size: /n�30J r` <br /> 46,rc )OAaJ- s <br /> Aces; <br /> 0-s cam <br /> (If parcel is to be surveyed,provide preliminary map. See attached for preliminary map requirements.) <br /> Proposed access to public road: -F;rOnja ,e 0-SM <br /> Proposed access to public waters to be provided YQ p <br /> r <br /> w <br /> If yes,describe access: J <br /> J <br /> Does parcel meet Zoning Requirements? Yes No , <br /> Does parcel require a Survey? Yes No �fi� I e <br /> a <br /> Permit application fees submitted? Amount S .LD Receipt# �. °e <br /> w <br /> A <br /> 7 <br /> ❑ Reconciles With Real Property Listeres No Date: L3 q <br /> a � <br /> If not,explain: <br /> 0 <br /> a / <br /> W l.0 <br /> Application: Approved Denied Reason for Denial: ��1 i✓1 �� '�— OG <br /> Land Use: Date: _a 7-03 <br /> 2/l8/2003 <br /> V <br />